Bito, Tomohiro; Matsunaga, Yohei; Yabuta, Yukinori; Kawano, Tsuyoshi; Watanabe, Fumio
Vitamin B12 (B12) deficiency has been linked to developmental disorders, metabolic abnormalities, and neuropathy; however, the mechanisms involved remain poorly understood. Caenorhabditis elegans grown under B12-deficient conditions for five generations develop severe B12 deficiency associated with various phenotypes that include decreased egg-laying capacity (infertility), prolonged life cycle (growth retardation), and reduced lifespan. These phenotypes resemble the consequences of B12 defic...
... tongue or bleeding gums If you have low vitamin B12 level for a long time, you can have nerve damage. Symptoms of nerve damage include: Confusion or change in mental status ( dementia ) in severe cases Depression Loss of balance Numbness ...
Vitamin B12 deficiency may cause psychiatric manifestations preceding the hematological and neurological symptoms. Despite a variety of symptoms, data on the role of vitamin B12 deficiency in depression are sparse. We report a case with B12 deficiency that is diagnosed with psychotic depression and treated successively with vitamin B12 replacement instead of using conventional therapy. Future investigations should focus on the role of vitamin B12 status in depression and other neurops...
Vitamin B12 deficiency may cause psychiatric manifestations preceding the hematological and neurological symptoms. Despite a variety of symptoms, data on the role of vitamin B12 deficiency in depression are sparse.We report a case with B12 deficiency that is diagnosed with psychotic depression and treated successively with vitamin B12 replacement instead of using conventional therapy.Future investigations should focus on the role of vitamin B12 status in depression and other neuropsychiatric ...
Vitamin B12 (cobalamin) deficiency occurs primarily as a result of insufficient dietary intake or poor absorp-tion. There is widespread global prevalence of vitamin B12 deficiency, resulting in considerable morbidity.
Vitamin B12 (cobalamin) deficiency occurs primarily as a result of insufficient dietary intake or poor absorp-tion. There is widespread global prevalence of vitamin B12 deficiency, resulting in considerable morbidity.
In considering the vitamin B-12 fortification of flour, it is important to know who is at risk of vitamin B-12 deficiency and whether those individuals would benefit from flour fortification.This article reviews current knowledge of the prevalence and causes of vitamin B-12 deficiency and considers ...
Haider, S.; Ahmad, N; Anaissie, E J; Abdel Karim, N.
Vitamin B12 deficiency can present with various hematological, gastrointestinal and neurological manifestations. We report a case of elderly female who presented with neuropathy and vitamin B12 deficiency where the final work-up revealed polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS). This case suggests that, although POEMS syndrome is a rare entity, it can present with vitamin-B12 deficiency and thus specific work up for early diagnosis of P...
Leischker, A H; Kolb, G F
The prevalence of vitamin B12 deficiency increases with age. Patients with dementia and spouses of patients with dementia are at special risk for the development of vitamin B12 deficiency. In a normal diet this vitamin is present only in animal source foods; therefore, vegans frequently develop vitamin B12 deficiency if not using supplements or foods fortified with cobalamin. Apart from dementia, most of these manifestations are completely reversible under correct therapy; therefore it is crucial to identify and to treat even atypical presentations of vitamin B12 deficiency as early as possible. This article deals with the physiology and pathophysiology of vitamin B12 metabolism. A practice-oriented algorithm which also considers health economic aspects for a rational laboratory diagnosis of vitamin B12 deficiency is presented. In cases with severe neurological symptoms, therapy should be parenteral, especially initially. For parenteral treatment, hydroxocobalamin is the drug of choice. PMID:25586321
Russcher, Henk; Heil, Sandra G; Slobbe, Lennert; Lindemans, Jan
A 28-year-old female vegetarian was referred to a specialist in internal medicine with persistent iron deficiency. Laboratory analysis revealed microcytic anaemia with low ferritin levels but normal total vitamin B12 levels. The red blood cell distribution width, however, showed a very wide variation in red blood cell sizes, indicating a coexisting vitamin B12 deficiency, which was confirmed by the low concentration of active vitamin B12. Another patient, a 69-year-old woman with a history of previous gastric surgery and renal insufficiency as a complication of diabetes mellitus, was suspected to be deficient in vitamin B12, as she had low total vitamin B12 levels and an accumulation of methylmalonic acid and homocysteine in her blood. Testing the total concentration of vitamin B12 alone has insufficient diagnostic accuracy and no accepted gold standard is available for diagnosing vitamin B12 deficiency. With the development of newer tests, such as measuring holotranscobalamin II (concentration of active vitamin B12), atypical and subclinical deficiency states can be recognized. A new approach to diagnosing vitamin B12 deficiency is presented, based upon these 2 case descriptions. PMID:22217304
Khodabandehloo, Niloofar; Vakili, Masoud; Hashemian, Zahra; Zare Zardini, Hadi
Background: Elevated concentration of serum total homocysteine usually occurs in vitamin B-12 deficiency. This metabolite can be measured and used for screening functional vitamin B-12 deficiency. Objectives: We assessed functional vitamin B12 deficiency in Tehranian elderly admitted to elderly research center, University of Social Welfare and Rehabilitation Sciences. Patients and Materials: A cross-sectional study was performed on 232 elderly admitted to elderly research center in Tehran, Iran in 2012. According to other studies, individuals were classified into two groups: high risk of vitamin B-12 deficiency (homocysteine (> 15 micmol/L). Results: Cut-off of 15.0 pmol/L for homocysteine was identified for persons with normal or elevated concentrations. Among persons aged 65–74 and ≥ 75 years, respectively, 56% and 93% were at high risk of vitamin B-12 deficiency. Conclusions: The prevalence of B12 deficiency was higher in this study compared to other studies, so more attention and massive efficacious policy should be designed to reduce the deficiency of this vitamin. PMID:26430518
Javid, Parva; Christensen, Erik
Since vegetarians have a lower intake of vitamin B12 (B12) than non-vegetarians, they are at increased risk of developing B12 deficiency. The less animal products the food contains the worse the B12 status. However, even lacto-ovo-vegetarians run the risk of becoming deficient in B12. Vegetarians are recommended regularly to take supplements of B12, and they should be informed of the lacking content of B12 of plant products and the hazards of B12 deficiency. Furthermore, vegetarians should routinely be checked for possible B12 deficiency. PMID:26750191
Maryam Valizadeh; Nasim Valizadeh
B12 acts as a cofactor in synthesis of neurotransmitters such as serotonin and dopamine, thus B12 deficiency affects mood, emotions and sleeping and can lead to psychiatric disorders. Psychiatric manifestations of B12 deficiency are varied. They seldom precede anemia. We want to present a case of B12 deficiency which was presented with obsessive compulsive disorder.
Rasmussen, Heather E.; Gustashaw, Kristin A. R.; Tangney, Christy C; Breanna S. Oberlin
This study was designed to assess whether symptoms, functional measures, and reported disabilities were associated with vitamin B12 (B12) deficiency when defined in three ways. Participants, aged 60 or more years of age, in 1999–2002 National Health and Nutrition Examination Surveys (NHANES) were categorized in relation to three previously used definitions of B12 deficiency: (1) serum B12 20 μmol/L; and (3) serum B12 < 258 pmol...
Agrawal, Sanwar; Nathani, Shweta
Neuroregression in infants has varied aetiology and vitamin B12 deficiency is one of the uncommon causes. Infantile vitamin B12 deficiency is encountered in malnourished infants or in offspring of strict vegan mothers. We present two cases, both infants of 10 and 8 months of age, whose mothers had vitamin B12 deficiency. On admission, the patients were apathic, hypotonic and lethargic. Serum vitamin B12 levels were below normal limits. On cranial MRI, T2-weighted images revealed frontoparieta...
KR Dholakia; TS Dharmarajan; D Yadav; S Oiseth; EP Norkus; CS Pitchumoni
AIM: To compare upper gastric endoscopic and histopathologic findings in older adults in the presence and absence of B12 deficiency.METHODS: A prospective analysis of upper gastric endoscopic and gastric histopathologic findings from 30 newly identified B12-deficient patients (11 males,19 females) and 16 controls with normal B12 status (6males, 10 females) was performed. For all subjects, the indication for upper endoscopy and gastric biopsy were unrelated to B12 status. A single pathologist, blinded to B12 status, processed and interpreted the biopsy samples. Endoscopic and histopathologic findings were correlated with age, gender, hematocrit (Hct), MCV and B12 status.RESULTS: The B12-deficient group had significantly lower mean serum B12 levels compared to the controls (P＜0.00005) while their mean Hct, MCV and serum albumin levels were similar. Iron deficiency (ferritinbased) was present in 21% of B12-deficient patients and intrinsic factor antibodies were present in29% (5/17) of B12-deficient patients. The endoscopic findings revealed significantly different rates of gastritis and atrophy between the B12-deficient and control groups (P= 0.017).B12-deficient patients had significantly less superficial gastritis (62% vs 94%) and significantly more atrophic gastritis (28% vs 0%) as compared to the controls (P= 0.039). Intestinal metaplasia was similar in both groups. Helicobacter pyloriinfection rates were similar in the B12-deficient patients and controls (40% vs31%).CONCLUSION: Significantly different endoscopic findings and types of gastritis could often be observed in the presence and absence of B12 deficiency. Atrophy,based on endoscopy, and atrophic gastritis, based on histopathology, suggest the presence of B12 deficiency.Gastric histopathology is not influenced by the age,gender, Hct or MCV of the patients.
Battaglia-Hsu, Shyue-Fang; Akchiche, Nassila; Noel, Nicole; Alberto, Jean-Marc; Jeannesson, Elise; Orozco-Barrios, Carlos Enrique; Martinez-Fong, Daniel; Daval, Jean-Luc; Guéant, Jean-Louis
Vitamin B12 (cobalamin, Cbl) is indispensable for proper brain development and functioning, suggesting that it has neurotrophic effects beside its well-known importance in metabolism. The molecular basis of these effects remains hypothetical, one of the reasons being that no efficient cell model has been made available for investigating the consequences of B12 cellular deficiency in neuronal cells. Here, we designed an approach by stable transfection of NIE115 neuroblastoma cells to impose th...
Full Text Available The present report highlights an unusual presentation of vitamin B12 deficiency recurrent seizures in a 26-year-old man. His symptoms responded to parenteral vitamin B12 therapy. The relevant literature is reviewed.
Agrawal, Sanwar; Nathani, Shweta
Neuroregression in infants has varied aetiology and vitamin B12 deficiency is one of the uncommon causes. Infantile vitamin B12 deficiency is encountered in malnourished infants or in offspring of strict vegan mothers. We present two cases, both infants of 10 and 8 months of age, whose mothers had vitamin B12 deficiency. On admission, the patients were apathic, hypotonic and lethargic. Serum vitamin B12 levels were below normal limits. On cranial MRI, T2-weighted images revealed frontoparietal cortical atrophy. Both the infants responded to vitamin B12 treatment. PMID:21686891
Massey, Thomas H; Pickersgill, Trevor T; J Peall, Kathryn
A 36-year-old man presented to hospital with a 5-week history of ascending limb paraesthesiae and balance difficulties. He had no medical or travel history of note, but admitted habitual nitrous oxide (N2O) inhalation. Neurological examination revealed a sensory ataxia with pseudoathetosis in the upper limbs and reduced vibration sensation to the hips bilaterally. Significant investigation results included a low serum vitamin B12 concentration, mild macrocytosis and raised serum homocysteine concentration. T2 MRI of the spinal cord demonstrated increased signal extending from C1 to T11 in keeping with a longitudinal myelitis. The patient was diagnosed with a myeloneuropathy secondary to vitamin B12 deficiency, resulting from heavy N2O inhalation. He was treated with intramuscular vitamin B12 injections and received regular physiotherapy. At discharge, he was able to mobilise short distances with the aid of a zimmer frame, and was independently mobile 8 weeks later. PMID:27247211
Vitamin deficiency is one of the major causes of treatable dementia. Specifically, patients suffering from dementia frequentry display low serum levels of vitamin B(12). There is a close metabolic interaction between folate and vitamin B(12). Folate deficiency causes various neuropsychiatric symptoms, which resemble those observed in vitamin B(12) deficiency. This review summarizes, the basic pathophysiology of vitamin B(12) and folate deficiency, its clinical diagnosis, associated neuropsychiatric symptoms such as subacute combined degeneration and dementia, and epidemiological studies of cognitive decline and brain atrophy. PMID:27056859
Durand, C; Mary, S; Brazo, P; Dollfus, S
Psychiatric manifestations are frequently associated with pernicious anemia including depression, mania, psychosis, dementia. We report a case of a patient with vitamin B12 deficiency, who has presented severe depression with delusion and Capgras' syndrome, delusion with lability of mood and hypomania successively, during a period of two Months. Case report - Mme V., a 64-Year-old woman, was admitted to the hospital because of confusion. She had no history of psychiatric problems. She had history of diabetes, hypertension and femoral prosthesis. The red blood count revealed a normocytosis with anemia (hemoglobin=11,4 g/dl). At admission she was uncooperative, disoriented in time and presented memory and attention impairment and sleep disorders. She seemed sad and older than her real age. Facial expression and spontaneous movements were reduced, her speech and movements were very slow. She had depressed mood, guilt complex, incurability and devaluation impressions. She had a Capgras' syndrome and delusion of persecution. Her neurologic examination, cerebral scanner and EEG were postponed because of uncooperation. Further investigations confirmed anemia (hemoglobin=11,4 g/dl) and revealed vitamin B12 deficiency (52 pmol/l) and normal folate level. Antibodies to parietal cells were positive in the serum and antibodies to intrinsic factor were negative. An iron deficiency was associated (serum iron=7 micromol/l; serum ferritin concentration=24 mg/l; serum transferrin concentration=3,16 g/l). This association explained normocytocis anemia. Thyroid function, hepatic and renal tests, glycemia, TP, TCA, VS, VDRL-TPHA were normal. Vitamin B12 replacement therapy was started with hydroxycobalamin 1 000 ng/day im for 10 days and iron replacement therapy. Her mental state improved dramatically within a few days. After one week of treatment the only remaining symptoms were lability of mood, delusion of persecution, Capgras' syndrome but disappeared totally 9 days after the
O'Gorman, P; Holmes, D; Ramanan, A V; Bose-Haider, B; Lewis, M J; Will, A
Dietary deficiency of cobalamin resulting in tissue deficiency in white individuals is unusual. However, several patients with dietary deficiency who were neither vegan nor Hindu have been described. This report describes the case of a 14 year old boy who was a white non-Hindu with a very low intake of cobalamin, which was not apparent until a detailed dietary assessment was performed. The patient responded rapidly to a combination of oral and parenteral B12. This case illustrates the fact that severe dietary vitamin B12 deficiency can occur in non-Hindu white individuals. Inadequate dietary content of B12 may not be apparent until a detailed dietary assessment is performed. This patient is likely to have had subclinical vitamin B12 deficiency for several years. Increased vitamin B12 requirements associated with the adolescent growth spurt may have provoked overt tissue deficiency. PMID:12037034
Ganjehei, Leila; Massumi, Ali; Razavi, Mehdi; James M Wilson
A 90-year-old woman with orthostatic hypotension and near-syncope was found to have a low-normal level of vitamin B12 and no other medical findings that could explain her orthostasis. Her symptoms responded to vitamin B12 replacement therapy. This case shows that vitamin B12 deficiency can induce orthostatic hypotension and syncope that are correctable by vitamin B12 replacement.
Hemlata Bhaskar; Rekha Chaudhary
Background. Vitamin B12 is vital for optimal functioning of various organ systems but more importantly the central nervous system and the hematological system. Deficiency of vitamin B12 clinically manifests as excessive daytime fatigue, memory difficulties, encephalopathy, myelopathy, peripheral neuropathy, and optic neuropathy. In occupational medicine, vitamin B12 deficiency has been reported with exposure to nitrous oxide in health care workers. However, not much is known about exposure to...
İNCECİK, Faruk; HERGÜNER, Mihriban Özlem; Altunbaşak, Şakir
Objective: The abstract presents 7 striking cases who presented with the complaint of seizures showing concomitance of B12 vitamin deficiency. Material and Methods: Participant patients were those who presented at our hospital with seizures caused by B12 vitamin deficiency. Evaluation was based on clinical, physical and neurological signs of the patients. Complete hemogram, peripheral blood view, vitamin B12 level and folic acid level measurements were performed. Cerebral magnetic r...
KARLI, R.; Gül, A; UĞUR, B.
SUMMARY The aim of this study was to investigate the possible association between otoacoustic emission (OAE) values and cochlear function in patients with vitamin B12 deficiency and no evidence of symptomatic hearing loss. Two groups were studied: Group 1: patients with vitamin B12 deficiency; Group 2: a matched control group of patients with normal vitamin B12 levels. There was no evidence of symptomatic hearing loss in either group. Transiently evoked OAEs (TEOAEs) and spontaneous OAEs (SOA...
Heather E. Rasmussen
Full Text Available This study was designed to assess whether symptoms, functional measures, and reported disabilities were associated with vitamin B12 (B12 deficiency when defined in three ways. Participants, aged 60 or more years of age, in 1999–2002 National Health and Nutrition Examination Surveys (NHANES were categorized in relation to three previously used definitions of B12 deficiency: (1 serum B12 20 μmol/L; and (3 serum B12 0.21 μmol/L. Functional measures of peripheral neuropathy, balance, cognitive function, gait speed, along with self-reported disability (including activities of daily living were examined with standardized instruments by trained NHANES interviewers and technicians. Individuals identified as B12 deficient by definition 2 were more likely to manifest peripheral neuropathy OR (odds (95% confidence intervals, p value: 9.70 (2.24, 42.07, 0.004 and report greater total disability, 19.61 (6.22, 61.86 0.0001 after adjustments for age, sex, race, serum creatinine, and ferritin concentrations, smoking, diabetes, and peripheral artery disease. Smaller, but significantly increased, odds of peripheral neuropathy and total disability were also observed when definition 3 was applied. Functional measures and reported disabilities were associated with B12 deficiency definitions that include B12 biomarkers (homocysteine or methylmalonic acid. Further study of these definitions is needed to alert clinicians of possible subclinical B12 deficiency because functional decline amongst older adults may be correctable if the individual is B12 replete.
It became apparent in 1978 that some radioassays for Vitamin B-12 were falsely normal. This investigation was performed to assure the accuracy of our assay. False normal B-12 levels may result in permanent damage or delay in relieving distressful symptoms. False low levels result in no permanent sequalae. ''Normal'' values should be set with these consequences in mind. The authors reviewed clinical charts on patients with <300 pg/m1 serum B-12 in 1000 consecutive determinations and all patients newly diagnosed B-12 deficient 1/1/83 to 10/14/83. Simu1TRAC Radioassay, Becton Dickinson Co., modified by correction for serum nonspecific binding is used. ''Normal'' values (234-1000 pg/m1) are based on 47 outpatients. 176 of the 1000 assays resulted in levels <300 pg/m1. 87 were from other location with no clinical information. 89 assays on Marshfield Clinic patients included 2 duplicates. 45 patients were newly diagnosed B-12 deficient 1/1/83 to 10/14/83. 12 were diagnosed elsewhere and on therapy. 32 had assays <234 pg/m1. 1 with normal B-12 is ''possibly deficient'', a Schilling test is scheduled. The authors conclude that their B-12 assay has correctly identified 32 clinically accepted B-12 deficient patients. 1 possibly deficient patient was normal. 25 of 42 patients with levels below normal are deficient. The false positive rate is felt acceptable in view of the false negative rate and the consequences of the respective errors
Full Text Available This is a study of B12 and folate deficiency in a hospital population. We studied the incidence of their deficiency by evaluating blood levels in every tenth hospital admission. Among the 450 patients chosen, 417 had normal levels of both, 2 had deficiency of folate alone (folate < 3ng.ml, 3 had B12 deficiency alone (B12<200pg/mland 11 had deficiency of both (total 3.5%. In addition 12 had borderline b12 level(200-300pg/ml, 2 had borderline folate level (3-4ng/ml(0.44%and 3 had borderline levels for both (0.66% . Thus 33% had definite or borderline deficiency. This deficiency was more common in the elderly and in patients on vegetarian diet (5.7% definite deficiency, 8.8% borderline levels compared to those on a non-vegetarian diet. During the 2 1/2 years of the study a total of 99 definite deficiency and 69 borderline deficiency were seen. In the definite deficiency group, 22.3% had neuropathy, 6.1% had evidence of myelopathy, 18.2% had neuropsychiatric changes (memory defect, dementia, behavioural abnormalities, depression and 4.1% had cerebellar signs. The neurologic findings in the borderline group were almost similar (neuropathy 29%, myelopathy 8.6% and neuropsychiatric changes 18.4%. High mean corpuscular volume (MCV> 95 was seen in 69% of those with both B12 and folate deficiency, 43.4% with B12 deficiency and 61.15 with folate deficiency. Hypersegmented polymorphs were seen in 21.7% with B12 deficiency, 27.5% with folate both B12 and folate deficiency had either megaloblastosis or dimorphic picture. It is to be noted that B12 and folate deficiency in this population was more frequent than we previously considered and reliance on haematologic parameters will miss half to one third of all cases. As expected B12 deficiency is more frequent in vegetarians than non-vegetarians.
The clinical presentation of patients with vitamin B12 deficiency varies in a spectrum ranging from haematological disorders to neuropsychiatric diseases. In rare cases, orthostatic hypotension, impotence, constipation and urinary retention have been attributed to autonomic nervous system dysfunction due to vitamin B12 deficiency. The aim of this study was to evaluate the effect of vitamin B12 deficiency on autonomic nervous system function by studying gastric emptying times (T1/2). Twenty patients with newly diagnosed vitamin B12 deficiency and 12 control patients with gastritis and normal vitamin B12 levels were enrolled in this study. Gastroduodenoscopy, endoscopic biopsy, histopathological evaluation of the biopsy specimens and radionuclide gastric emptying studies were performed. After vitamin B12 replacement therapy for 3 months, radionuclide gastric emptying studies were repeated. Mean gastric emptying T1/2 in patients before and after treatment and in controls were 103.83±48.80 min, 90.00±17.29 min and 74.55±8.52 min, respectively. The difference in mean gastric emptying T1/2 between patients before treatment and controls was statistically significant (P12 treatment (P1/2 was somewhat shorter. There were no positive or negative correlations between gastric emptying T1/2 and the following parameters: haemoglobin, vitamin B12 level and Helicobacter pylori positivity. In conclusion, gastric emptying T1/2 was prolonged in patients with vitamin B12 deficiency and this prolongation was not corrected after vitamin B12 replacement therapy. Although autonomic nervous system dysfunction due to vitamin B12 deficiency rarely gives rise to clinical manifestations, latent dysfunction demonstrated by laboratory tests seems to be a frequent phenomenon. The level of vitamin B12 does not correlate with the degree of autonomic nervous system dysfunction measured by radionuclide gastric emptying studies. (orig.)
Vitamin B12 deficiency was found in 10 of 41 patients who underwent radiotherapy before cystectomy with Bricker urinary diversion for carcinoma of the bladder. Of 13 patients given full irradiation because of inoperable bladder cancer 5 had malabsorption of vitamin B12. Serum folic acid was normal in these patients, indicating predominantly ileal irradiation sequelae. Routine evaluation of serum vitamin B12 after radiotherapy is recommended so that appropriate medication can be given, if possible before neurological symptoms appear
This review describes current knowledge of the main causes of vitamin B12 and folate deficiency. The most common explanations for poor B12 status are a low dietary intake of the vitamin (i.e., a low intake of animal-source foods) and malabsorption. Although it has long been known that strict vegetar...
Chu, Colin; Scanlon, Peter
Asymptomatic bilateral optic disc swelling was detected in a 19-year-old man with type 1 diabetes through routine photographic screening for retinopathy. He was found to have significant vitamin B12 deficiency which the authors believe was the cause for the optic neuropathy. After B12 replacement, visual function and optic disc appearances returned to normal.
Pawlak, Roman; Parrott, Scott James; Raj, Sudha; Cullum-Dugan, Diana; Lucus, Debbie
Vegetarians are at risk for vitamin B(12) (B12) deficiency due to suboptimal intake. The goal of the present literature review was to assess the rate of B12 depletion and deficiency among vegetarians and vegans. Using a PubMed search to identify relevant publications, 18 articles were found that reported B12 deficiency rates from studies that identified deficiency by measuring methylmalonic acid, holo-transcobalamin II, or both. The deficiency rates reported for specific populations were as follows: 62% among pregnant women, between 25% and almost 86% among children, 21-41% among adolescents, and 11-90% among the elderly. Higher rates of deficiency were reported among vegans compared with vegetarians and among individuals who had adhered to a vegetarian diet since birth compared with those who had adopted such a diet later in life. The main finding of this review is that vegetarians develop B12 depletion or deficiency regardless of demographic characteristics, place of residency, age, or type of vegetarian diet. Vegetarians should thus take preventive measures to ensure adequate intake of this vitamin, including regular consumption of supplements containing B12. PMID:23356638
Vijay Kumar; Sandeep,; Sajjal; Shivraj B
OBJECTIVE: To investigate the etiological factors resulting in Vitamin B12 deficiency in patients with sub-acute combined degeneration (SACD) and other neurological manifestation manifestations. METHODS: We undertook a prospective study of 50 patients, all clinically suspected to have Vit B12 deficiency; they were investigated clinically, hematologically, biochemically and radiologically. RESULTS: There was a dominance of males (41of 50) with the majority in the age group ...
Cuffe, Kendra; Stauffer, William; Painter, John; Shetty, Sharmila; Montour, Jessica; Zhou, Weigong
In 2008, clinicians performing routine medical examinations in the United States reported high rates of hematologic and neurologic disorders caused by vitamin B12 deficiency in resettled Bhutanese refugees. To confirm this finding, CDC screened Bhutanese refugees' serum samples for vitamin B12 levels and found vitamin B12 deficiency in 64% (n = 99) of samples obtained before departure and 27% (n = 64) of samples obtained after arrival in the United States. In response, CDC recommended that arriving Bhutanese refugees receive oral vitamin B12 supplements and nutrition advice. In 2012, based on anecdotal reports of decreasing rates of vitamin B12 deficiency in this population, CDC worked with select domestic refugee health programs to determine if the recommendations had reduced the vitamin B12 deficiency rate among Bhutanese refugees. PMID:25029113
Roed, Casper; Skovby, Flemming; Lund, Allan Meldgaard
Weight loss and reduction of motor skills resulted in paediatric evaluation of a 10-month-old girl and a 12-month-old boy. Both children suffered form anaemia and delayed development due to vitamin B12 deficiency caused by strict maternal vegan diet during pregnancy and nursing. Therapy with cyanocobalamin was instituted with remission of symptoms. Since infants risk irreversible neurologic damage following severe vitamin B12 deficiency, early diagnosis and treatment are mandatory. Vegan and vegetarian women should take vitamin B12 supplementation during the pregnancy and nursing period. PMID:19852900
Rajsekhar, Putta; Reddy, Mugannagari Maheshwar; Vaddera, Sameeraja; Rajini, G; Tikeli, Vinil
Vitamin B12 deficiency is widespread than assumed in population. At risk are older people, pregnant women, vegans, patients with renal and intestinal diseases. Vitamin B12 deficiency can present with various hematological, gastrointestinal and neurological manifestations. In the population, the prevalence of vitamin B12 deficiency in younger people is 5% to 7% which is less compared to elderly people. In developing countries, deficiency is much more common, starting in early life and persisting across the life span. Here, we present a 16-year-old female patient presenting with ascites since 2 months who was subsequently investigated and diagnosed to have nutritional megaloblastic anaemia secondary to vitamin B12 deficiency after exclusion of other infective, neoplastic, autoimmune and inflammatory diseases. Inspite, patient was treated with antitubercular drugs but she did not respond. After supplementation of Vitamin B12, ascites responded well. Inadequate intake due to low consumption of animal source foods is the main cause of low serum vitamin B12 in younger adults and likely the main cause in poor population worldwide. PMID:25177593
Spence, J David
The purpose of this narrative review is to highlight insights into the importance and frequency of metabolic vitamin B12 (B12) deficiency, reasons why it is commonly missed, and reasons for the widespread but mistaken belief that treatment of B12 deficiency does not prevent stroke or improve cognitive function. Metabolic B12 deficiency is common, being present in 10%-40% of the population; is frequently missed; is easily treated; and contributes importantly to cognitive decline and stroke in older people. Measuring serum B12 alone is not sufficient for diagnosis; it is necessary to measure holotranscobalamin or functional markers of B12 adequacy such as methylmalonic acid or plasma total homocysteine. B-vitamin therapy with cyanocobalamin reduces the risk of stroke in patients with normal renal function but is harmful (perhaps because of thiocyanate accumulation from cyanide in cyanocobalamin) in patients with renal impairment. Methylcobalamin may be preferable in renal impairment. B12 therapy slowed gray matter atrophy and cognitive decline in the Homocysteine and B Vitamins in Cognitive Impairment Trial. Undiagnosed metabolic B12 deficiency may be an important missed opportunity for prevention of dementia and stroke; in patients with metabolic B12 deficiency, it would be prudent to offer inexpensive and nontoxic supplements of oral B12, preferably methylcobalamin or hydroxycobalamin. Future research is needed to distinguish the effects of thiocyanate from cyanocobalamin on hydrogen sulfide, and effects of treatment with methylcobalamin on cognitive function and stroke, particularly in patients with renal failure. PMID:26597770
Reinstatler, Lael; Qi, Yan Ping; Williamson, Rebecca S.; Garn, Joshua V.; Oakley, Godfrey P
OBJECTIVE To describe the prevalence of biochemical B12 deficiency in adults with type 2 diabetes taking metformin compared with those not taking metformin and those without diabetes, and explore whether this relationship is modified by vitamin B12 supplements. RESEARCH DESIGN AND METHODS Analysis of data on U.S. adults ≥50 years of age with (n = 1,621) or without type 2 diabetes (n = 6,867) from the National Health and Nutrition Examination Survey (NHANES), 1999–2006. Type 2 diabetes was def...
Allen, Lindsay H
This review describes current knowledge of the main causes of vitamin B12 and folate deficiency. The most common explanations for poor vitamin B12 status are a low dietary intake of the vitamin (i.e., a low intake of animal-source foods) and malabsorption. Although it has long been known that strict vegetarians (vegans) are at risk for vitamin B12 deficiency, evidence now indicates that low intakes of animal-source foods, such as occur in some lacto-ovo vegetarians and many less-industrialized countries, cause vitamin B12 depletion. Malabsorption of the vitamin is most commonly observed as food-bound cobalamin malabsorption due to gastric atrophy in the elderly, and probably as a result of Helicobacter pylori infection. There is growing evidence that gene polymorphisms in transcobalamins affect plasma vitamin B12 concentrations. The primary cause of folate deficiency is low intake of sources rich in the vitamin, such as legumes and green leafy vegetables, and the consumption of these foods may explain why folate status can be adequate in relatively poor populations. Other situations in which the risk of folate deficiency increases include lactation and alcoholism. PMID:18709879
Chalouhi, Christel; Faesch, Sabine; Anthoine-Milhomme, Marie-Constance; Fulla, Yvonne; Dulac, Olivier; Chéron, Gérard
In developed countries, the vitamin B12 deficiency usually occurs in children exclusively breast-fed, whose mothers are vegetarians, causing low stores of vitamin B12. Symptoms of vitamin B12 deficiency appear during the second trimester of life and include failure to thrive, lethargy, hypotonia, and arrest or regression of developmental skills. A megaloblastic anemia can be present. One half of the infants exhibit abnormal movements before the start of treatment with intramuscular cobalamin, which disappear 1 or 2 days after. More rarely, movement disorders appear a few days after treatment, whereas neurological symptoms are improving. These abnormal movements can last for 2 to 6 weeks. If not treated, vitamin B12 deficiency can cause lasting neurodisability. Therefore, efforts should be directed to preventing deficiency in pregnant and breast-feeding women on vegan diets and their infants by giving them vitamin B12 supplements. When preventive supplementation has failed, one should recognize and treat quickly an infant presenting with failure to thrive and delayed development. PMID:18708898
Andrès, Emmanuel; Loukili, Noureddine Henoun; Noel, Esther; Kaltenbach, Georges; Abdelgheni, Maher Ben; Perrin, Anne Elisabeth; Noblet-Dick, Marie; Maloisel, Frédéric; Schlienger, Jean-Louis; Blicklé, Jean-Frédéric
VITAMIN B12 OR COBALAMIN DEFICIENCY occurs frequently (> 20%) among elderly people, but it is often unrecognized because the clinical manifestations are subtle; they are also potentially serious, particularly from a neuropsychiatric and hematological perspective. Causes of the deficiency include, most frequently, food-cobalamin malabsorption syndrome (> 60% of all cases), pernicious anemia (15%–20% of all cases), insufficent dietary intake and malabsorption. Food-cobalamin malabsorption, whic...
Low levels of vitamin B 12 have been associated with several clinical conditions. However no single symptom or group of symptoms can be made responsible. Reported causes of deficiency among older population are hematologic or neurological, followed by gastrointestinal and possibly vascular symptoms. The present prospective observational study was, hence, initiated to evaluate the underlying clinical condition or symptoms associated with vitamin B12 deficiency. The study was prospective observational and carried out on 121 patients (males, n=63 and females, n=58) for the period from January 1, 2004 to January 24, 2007. Age ranges were between 16 - 70 years, and categorized as > 60 yrs and < 60 years. All blood parameters were analyzed by standardized methods on automated analyzers. The deficiency was found to be more prevalent in males and increased from 52.06% to 58.10% in individuals with vitamin B12 <150 pg/ml. Mal nourishment was noted among the most subjects and weakness and anemia were frequent clinical findings (35.55%, n=43, 14%, n=51). Other clinical conditions were neuropsychiatric. Whereas less frequent findings were paraesthesia and gastrointestinal symptoms. Hypertension was more prevalent in vitamin B12 deficient individuals followed by diabetes, dementia, stroke, ischemic heart disease and Parkinson's disease. (author)
Vitamin-B12 deficiency results from inadequate absorption of the vitamin by the distal ileum and depletion of available stores. Both radiotherapy and intestinal resection can contribute to development of this condition. The significance of this problem in gynecologic oncology is discussed and two patients are described
Clarke, Robert; Sherliker, Paul; Hin, Harold;
BACKGROUND: Impaired vitamin B(12) function and decreased vitamin B(12) status have been associated with neurological and cognitive impairment. Current assays analyze total vitamin B(12) concentration, only a small percentage of which is metabolically active. Concentrations of this active component......) concentrations as a marker of metabolic vitamin B(12) deficiency in the overall population (n = 2403) and in subsets with normal (n = 1651) and abnormal (n = 752) renal function. RESULTS: Among all participants, 6% had definite (MMA >0.75 micromol/L) and 16% had probable (MMA >0.45 micromol/L) metabolic vitamin...... abnormal (AUC: 0.85 vs 0.74; P = 0.002) renal function. Similar findings were observed for detection of moderate vitamin B(12) deficiency. Whereas the positive predictive value for both holoTC and vitamin B(12) was greater for detection of probable than definite vitamin B(12) deficiency, both tests were...
The goal of this paper is to describe the role of vitamin B12 deficiency in cardiovascular disease development among vegetarians. Vegetarians have a high prevalence of vitamin B12 deficiency. Deficiency of this vitamin is associated with a variety of atherogenic processes that are mainly, but not exclusively, due to vitamin B12 deficiency-induced hyperhomocysteinemia. Each 5-μmol/L increase above 10 μmol/L of serum homocysteine is associated with a 20% increased risk of circulatory health problems. Mean homocysteine concentration >10 μmol/L among vegetarians was reported in 32 of 34 reports. Macrocytosis associated with vitamin B12 deficiency is also associated with fatal and non-fatal coronary disease, myocardial infarction, stroke, and other circulatory health problems. Compared with non-vegetarians, vegetarians have an improved profile of the traditional cardiovascular disease risk factors, including serum lipids, blood pressure, serum glucose concentration, and weight status. However, not all studies that assessed cardiovascular disease incidence among vegetarians reported a protective effect. Among studies that did show a lower prevalence of circulatory health problems, the effect was not as pronounced as expected, which may be a result of poor vitamin B12 status due to a vegetarian diet. Vitamin B12 deficiency may negate the cardiovascular disease prevention benefits of vegetarian diets. In order to further reduce the risk of cardiovascular disease, vegetarians should be advised to use vitamin B12 supplements. PMID:25998928
Martinez Estrada, K M; Cadabal Rodriguez, T; Miguens Blanco, I; García Méndez, L
Isolated vitamin B12 deficiency is a common condition in elderly patients but uncommon in patients younger than 30 years, with an average age of onset between 60 and 70 years. This is because the dietary cobalamin, which is normally split by enzymes in meat in the presence of hydrochloric acid and pepsin in the stomach, is not released in the stomachs of elderly patients, usually due to achlorhydria. Although the body may be unable to release cobalamin it does retain the ability to absorb vitamin B12 in its crystalline form, which is present in multivitamin preparations. Other causes are due to drugs that suppress gastric acid production. Neurological signs of vitamin B12 deficiency can occur in patients with a normal haematocrit and red cell indices. They include paresthesia, loss of sensation and strength in the limbs, and ataxia. Reflexes may be slowed down or increased. Romberg and Babinsky signs may be positive, and vibration and position sensitivity often decreases. Behavoural disorders range from irritability and memory loss to severe dementia. The symptoms often do not fully respond to treatment. A case is presented of an isolated vitamin B12 deficiency in 27 year-old female patient who was seen in primary health care. During anamnesis she mentioned low back pain, to which she attributed the loss of strength and tenderness in the right side of the body, as well as the slow and progressive onset of accompanied headache for the previous 4 days. PMID:23834987
Full Text Available Background: To report a case of severe vitamin B12 deficiency anemia presenting with white centered retinal hemorrhages. Methods: Interventional case report. Results: A 40-year-old man, general practitioner himself, presented with a 1-day history of diminished left visual acuity and a drop-shaped central scotoma. The corrected visual acuities were 20/20, OD and 20/100, OS. Ophthalmic examination revealed bilaterally pale tarsal conjunctiva, discretely icteric bulbar conjunctiva and disseminated white centered intraretinal hemorrhages with foveal involvement. OCT imaging through these lesions revealed a retinal thickening caused by a sub-ILM accumulation of hyperreflective and inhomogeneous deposits within the nerve fiber layer. Immediate laboratory work-up showed severe megaloblastic anemia caused by vitamin B12 deficiency requiring erythrocyte transfusions. Discussion: Most reports of white centered retinal hemorrhages have been described in patients with leukemic retinopathy and bacterial endocarditis. It is interesting that this case of vitamin B12 deficiency anemia retinopathy has a clinically indistinguishable fundus appearance. This is probably due to the common pathology of capillary disruption and subsequent hemostatic fibrin plug formation. In megaloblastic anemia, direct anoxia results in endothelial dysfunction. The loss of impermeability allows extrusion of whole blood and subsequent diffusion from the disrupted site throughout and above the nerve fiber layer. Therefore the biomicroscopic pattern of white centered hemorrhages observed in anemic retinopathy is most likely due to the clot formation as the reparative sequence after capillary rupture.
Full Text Available OBJECTIVE: To investigate the etiological factors resulting in Vitamin B12 deficiency in patients with sub-acute combined degeneration (SACD and other neurological manifestation manifestations. METHODS: We undertook a prospective study of 50 patients, all clinically suspected to have Vit B12 deficiency; they were investigated clinically, hematologically, biochemically and radiologically. RESULTS: There was a dominance of males (41of 50 with the majority in the age group of more than 40 years of age. There was no correlation between the socio-economic and dietary status on the one hand and the clinical manifestation on the other. Anti-intrinsic factor antibodies (AIFAB were positive in 19 of 50 patients (38% and anti-parietal cell antibodies (APCAB were positive in 28 of 50(56% patients. CONCLUSION: We conclude that Pernicious anemia is an important cause of various neurological manifestations including s ACD in the Vitamin B12 deficient population in the age group of more than 40 years, irrespective of the socio-economic and dietary status in the Indian subcontinent. It is supported by the presence of AIFAB ro APCAB in this group
Crawford, John Ross; Say, Daphne
A previously healthy 7-year-old Caucasian boy was hospitalised for evaluation of acute ataxia and failure to thrive, initially suspicious for an intracranial mass. Weight and body mass index were below the third percentile and he demonstrated loss of joint position and vibratory sense on examination. Laboratory studies revealed megaloblastic anaemia while an initial MRI of the brain showed no evidence of mass lesions or other abnormalities. A dietary history revealed the child subscribed to a restrictive vegan diet with little to no intake of animal products or other fortified foods. The child was diagnosed with presumed vitamin B12 deficiency and was treated with intramuscular B12 injections. Neurological symptoms resolved promptly within several days after starting therapy. This case underlines the importance of assessing nutritional status in the evaluation of neurological dysfunction in the pediatric patient. PMID:23536622
Ebru Yilmaz Keskin; Basar Demir; Mahir igde; Banu Gulcan Oksuz
Purpose: Vitamin B12 deficiency in infancy can cause severe demyelinating central nervous system disorder. Most cases are exclusively breast-fed infants born to mothers with deficient vitamin B12 stores. As maternal vitamin B12 stores are the main determinant of neonatal vitamin B12 status, we aimed to determine the vitamin B12 status of pregnant women at term in our region. Materials and Methods: Serum vitamin B12, folate and plasma homocysteine concentrations in addition to routine test...
In DNA synthesis deoxythymidine kinase (TK) catalyses the conversion of deoxythymidine to deoxythymidine monophosphate (dTMP) via the 'salvage pathway'. Serum deoxythymidine kinase (S=TK) was measured in this study in 75 patients with vitamin B12 deficiency by a new, very sensitive method, using 125I-deoxyuridine as substrate. Elevated S-TK levels were found in those patients who had developed haemolysis and anaemia and the more advanced the disease the higher the S-TK value. Thus there was a highly significant correlation between S-TK, haemoglobin level and lactic dehydrogenase activity. These findings are consistent with the theory that elevated levels of S-TK are due to release from unstable proliferating tissue. (author)
Selhub, Jacob; Morris, Martha Savaria; Jacques, Paul F.; Rosenberg, Irwin H.
Previous reports on pernicious anemia treatment suggested that high folic acid intake adversely influences the natural history of vitamin B-12 deficiency, which affects many elderly individuals. However, experimental investigation of this hypothesis is unethical, and the few existing observational data are inconclusive. With the use of data from the 1999–2002 National Health and Nutrition Examination Survey (NHANES), we evaluated the interaction between high serum folate and low vitamin B-12 ...
Sahoo, Manoj Kumar; Avasthi, Ajit; Singh, Parampreet
Long lists of psychiatric illness or symptoms have been documented to be caused by vitamin B12 deficiency. We describe an atypical case of a young adult who presented with predominant negative symptoms followed by neurological symptoms consistent with vitamin B12 deficiency. The symptoms showed complete remission after vitamin B12 supplementation. The uniqueness of this case is that vitamin B12 deficiency presented with predominant negative symptoms without other psychotic and manic symptoms,...
Bergesen, O; Schjønsby, H; Schjerven, L
The influence of calcium on vitamin B12 absorption was investigated in two experiments. In the first we investigated whether B12 malabsorption in rats with biliary diversion through choledochocolic fistula is caused by deficiency of calcium in the small intestine. Calcium concentrations were measured in 10 fistula- and 10 sham-operated rats. Fistula rats had steatorrhea, but the concentration of calcium in the intestinal lumen was increased. In the second experiment we studied the effect of calcium deficiency on B12 absorption. Ten young rats were fed a low-calcium diet and 10 rats a control diet for 4 weeks. Rats on the low-calcium diet had moderately reduced calcium concentration in the blood and in the intestinal juice but unaltered calcium concentration in the cytosol fraction of intestinal mucosal scrapings. The absorption of 57CoB12 was unimpaired. This suggests that moderate calcium deficiency does not influence the intestinal absorption of vitamin B12 in the rat. PMID:2320946
Mohamad Reza Najafi; Vahid Shaygannajad; Maryam Mirpourian; Ali Gholamrezaei
Background: Vitamin B 12 (Cobalamin) deficiency can result in some clinical and paraclinical characteristics similar to what is seen in multiple sclerosis (MS) patients. This study aimed to evaluate the controversial association between vitamin B 12 deficiency and MS. Methods: We measured serum vitamin B 12 in 60 patients with MS and 38 healthy controls. Clinical disability was evaluated according to the Extended Disability Status Scale (EDSS). Serum B 12 concentration was measured with R...
Full Text Available Vitamin B12 deficiency usually presents with pernicious anemia or various neuropsychiatric manifestations. Commonly seen neuropsychiatric manifestations include large fiber neuropathy, myelopathy (subacute combined degeneration of the spinal cord, dementia, cerebellar ataxia, optic atrophy, psychosis and mood disorders. The present report highlights an unusual presentation of vitamin B12 deficiency- acute onset extrapyramidal syndrome in a 55-year-old man. The patient presented with a 10-day history of slowness of all activities including a slow gait, mild tremors of hands and low volume speech. On examination, he had features of mask-like facies, reduced blink rate and cogwheel rigidity. He was investigated for the possible causes and was found to have laboratory features of vitamin B12 deficiency. Other causes for acute onset parkinsonism were excluded by appropriate investigations. He showed a dramatic improvement following treatment with intramuscular vitamin B12 injections. At a five-year follow up, he was found to be functionally independent with no neurological deficits.
Sayın, Selim; Arslan, Erol; Demirbaş, Şeref; ESER, Mithat; Kenan SAĞLAM
Patients with vitamin B12 deficiency may present with hematologic, neuropsychiatric and cardiovascular symptoms. A clinical Picture of acute psychosis can be seen in rare cases and if not corrected, vitamin B12 deficiency can lead to permanent demage. Acute psychosis and symptoms of anemia with sixty-year-old male patient was evaluated and found that vitamin B12 deficiency due to the terminal ileitis. The patient was healed without permanent damage with replacement therapy.The diagnosis and t...
Melike Sezgin Evim; Şahin Erdöl; Özlem Özdemir; Birol Baytan; Adalet Meral Güneş
Objective: Vitamin B12 deficiency is frequently observed in developing countries. Herein we report the long-term clinical and laboratory outcomes in 45 children presented with various symptoms of vitamin B12 deficiency.Materials and Methods: Symptoms and physical findings, and percentiles for weight, height, and head circumference at presentation were recorded. The educational level of the patients’ mothers, vitamin B12 deficiency-related diseases and family income data were collected. Compl...
Bito, Tomohiro; Watanabe, Fumio
Caenorhabditis elegans is a nematode that has been widely used as an animal for investigation of diverse biological phenomena. Vitamin B12 is essential for the growth of this worm, which contains two cobalamin-dependent enzymes, methylmalonyl-CoA mutase and methionine synthase. A full complement of gene homologs encoding the enzymes associated with the mammalian intercellular metabolic processes of vitamin B12 is identified in the genome of C elegans However, this worm has no orthologs of the vitamin B12-binders that participate in human intestinal absorption and blood circulation. When the worm is treated with a vitamin B12-deficient diet for five generations (15 days), it readily develops vitamin B12 deficiency, which induces worm phenotypes (infertility, delayed growth, and shorter lifespan) that resemble the symptoms of mammalian vitamin B12 deficiency. Such phenotypes associated with vitamin B12 deficiency were readily induced in the worm. PMID:27486161
Since 2008, approximately 30,000 Bhutanese refugees have been resettled in the United States. Routine medical examinations of refugees after arrival in resettlement states indicated hematologic and neurologic disorders caused by vitamin B12 deficiency. These cases were reported by examining physicians and state health departments to CDC, which initiated an investigation. This report summarizes the results of that investigation. Sera from overseas medical examinations, postarrival examinations in three state health departments (Minnesota, Utah, and Texas), and medical records and interviews at a health clinic in St. Paul, Minnesota, were evaluated. Vitamin B12 deficiency, defined as serum vitamin B12 concentration Bhutanese refugees screened for vitamin B12 deficiency at the St. Paul clinic. Although the deficiencies might be multifactorial, the main cause is thought to be the diet consumed by these refugees for nearly two decades in Nepal, which lacked meat, eggs, and dairy products, the major dietary sources of vitamin B12. Additionally, infection with Helicobacter pylori might play a role. Clinicians should be aware of the risk for vitamin B12 deficiency in Bhutanese refugees. All Bhutanese refugees should be given nutrition advice and should receive supplemental vitamin B12 upon arrival in the United States. In addition, refugees with clinical manifestations suggestive of deficiency should be tested for adequate serum vitamin B12 concentrations and, if found to have a B12 deficiency, screened for underlying causes, treated with parenteral vitamin B12 or high-dose oral supplements, and evaluated for response to therapy. PMID:21430638
Vitamin B12 (cobalamin) is an essential nutrient that is only obtained from foods of animal origin, such as meat, eggs and dairy products. Vitamin B12 plays an important role in DNA synthesis and neurological function. Thus its deficiency can lead to several neurological symptoms such as memory loss, dizziness and in severe cases may lead to dementia. Many factors can cause or lead to vitamin B-12 deficiency. Among these are malabsorption, several gastron intestinal problems (i.e. celiac disease, Crobn's disease) and gastrointestinal surgeries. diagnosis of vitamin B-12 status depends commonly on serum vitamin B12 which is nonspecific tool for the deficiency. Other more specific tests, which reflect true deficiency, include serum and urine methylmalonic aci de, total serum homocysteine and serum holotranscobalamin. Vitamin B12 deficiency is a worldwide public health problem; epidemiological studies showed that its prevalence in industrialized countries ranges from 5-60% of the population depending on the used cutoff point of cobalamin level. In Jordan, many reports were published on vitamin B 12 deficiency. However, these reports gave different results of its prevalence ranging from 16-48% depending on the serum vitamin B12 cutoff point used. A recent study showed a prevalence of true deficiency of 32.7% based on measuring both serum vitamin B12 level and plasma methylmalonic acid. (authors).
A K Singh
Full Text Available Context: Long-term metformin use has been hypothesized to cause B12 deficiency and neuropathy in Type 2 diabetes patients. However, there is a paucity of Indian data regarding the same. Aim: To compare the prevalence of B12 deficiency and peripheral neuropathy in patients with Type 2 diabetes mellitus treated with or without metformin. Materials and Methods: We recruited patients with Type 2 diabetes and divided them into metformin exposed and nonmetformin exposed groups. We measured baseline demographic variables like age, sex, vegetarian status, and HbA1c levels in both groups. We compared vitamin B12 levels and severity of peripheral neuropathy (using Toronto Clinical Scoring System (TCSS in both groups. Definite B12 deficiency was defined as B12 <150 pg/ml and possible B12 deficiency as <220 pg/ml. The difference in vitamin B12 levels and TCSS was calculated in both groups using independent samples t-test. Spearman′s rank correlation between cumulative metformin use and B12 level was calculated. Odds ratio of vitamin B12 deficiency in metformin exposed group was also estimated. Results: Mean serum B12 levels was significantly lower in metformin exposed group (n=84 compared with nonmetformin exposed group (n=52 (410±230.7 versus 549.2±244.7, P=0.0011. Mean neuropathy score was significantly higher in metformin exposed group. (5.72±2.04 versus 4.62±2.12, P=0.0064. Odds ratio for possible B12 deficiency was 4.45 (95% CI 1.24-15.97. There was significant negative correlation between cumulative metformin dose and vitamin B12 level (r=−0.68, P<0.0001. Conclusion: Metformin use is associated with vitamin B12 deficiency and clinical neuropathy in Type 2 diabetes patients.
Full Text Available Vitamin B12 deficiency usually presents with hematological or neuropsychiatric manifestations. The common clinical presentations include pernicious anemia, myelopathy (Subacute combined degeneration of the cord, myeloneuropathy, optic atrophy, dementia and psychosis. An uncommon manifestation of Vitamin B12 deficiency-acute onset mania-in a 25-years old man that responded to treatment is reported. Relevant literature is also reviewed.
Vitamin B12 deficiency usually presents with hematological or neuropsychiatric manifestations. The common clinical presentations include pernicious anemia, myelopathy (Subacute combined degeneration of the cord), myeloneuropathy, optic atrophy, dementia and psychosis. An uncommon manifestation of Vitamin B12 deficiency-acute onset mania-in a 25-years old man that responded to treatment is reported. Relevant literature is also reviewed.
Thomas Gregor Issac; Soundararajan Soundarya; Rita Christopher; Sadanandavalli Retnaswami Chandra
Background: Vitamin B12 deficiency is a common condition causing neurologic, cognitive, psychiatric, and mood symptoms. With varied religious, ethnic, and socioeconomic heterogeneity among the people in India greatly influencing their dietary habits and with the high prevalence of Helicobacter pylori infection, Vitamin B12 deficiency is not uncommon, but is often under recognized due to the lack of classical symptomatic presentation. Materials and Methods: Retrospective study on Vitamin B12 d...
Silva, Dina; Albers, Ulrike; Santana, Isabel; Vicente, Margarida; Martins, Isabel Pavão; Verdelho, Ana; Guerreiro, Manuela; de-Mendonça, Alexandre
Background Vitamin B12 deficiency is common in older people, and may be responsible for reversible dementia. Low serum vitamin B12 levels were also observed in patients with Mild Cognitive Impairment (MCI). It is not known whether patients with vitamin B12 deficiency have a distinctive profile of cognitive impairment different from the episodic memory deficit usually observed in MCI. Results From a cohort of 310 patients with MCI followed in a memory clinic in Lisbon, only 10 cases with vitam...
Kocaoglu, Celebi; Akin, Fatih; Çaksen, Hüseyin; Böke, Saltuk Buğra; Arslan, Şükrü; Aygün, Serhat
ABSTRACT In developed countries, vitamin B12 (cobalamin) deficiency usually occurs in children, exclusively breastfed ones whose mothers are vegetarian, causing low body stores of vitamin B12. The haematologic manifestation of vitamin B12 deficiency is pernicious anaemia. It is a megaloblastic anaemia with high mean corpuscular volume and typical morphological features, such as hyperlobulation of the nuclei of the granulocytes. In advanced cases, neutropaenia and thrombocytopaenia can occur, ...
The challenges in medical management of cobalamin deficiency lie in attention to the unique pathophysiology that underlies cobalamin deficiency, more than in the mechanics of therapy. The central physiologic principles are that clinically important deficiency is more likely to occur (and progress) when intrinsic factor–driven absorption fails than when diet is poor and that most causes take years to produce clinically obvious deficiency. Transient defects have little clinical impact. The key ...
van der Wal, Haye H.; Comin-Colet, Josep; Klip, Ijsbrand T.; Enjuanes, Cristina; Grote Beverborg, Niels; Voors, Adriaan A.; Banasiak, Waldemar; van Veldhuisen, Dirk J.; Bruguera, Jordi; Ponikowski, Piotr; Jankowska, Ewa A.; van der Meer, Peter
Objective To determine the prevalence, clinical correlates and the effects on outcome of vitamin B-12 and folic acid levels in patients with chronic heart failure (HF). Methods We studied an international pooled cohort comprising 610 patients with chronic HF. The main outcome measure was all-cause m
Johnson, Mary Ann
The most common cause of vitamin B12 deficiency in older people is malabsorption of food-bound vitamin B12. Thus, it is suggested that the recommended daily allowance of 2.4 microg/d be met primarily with crystalline vitamin B12, which is believed to be well absorbed in individuals who have food-bound malabsorption. There is concern that high intakes of folic acid from fortified food and dietary supplements might mask the macrocytic anemia of vitamin B12 deficiency, thereby eliminating an important diagnostic sign. One recent study indicates that high serum folate levels during vitamin B12 deficiency exacerbate (rather than mask) anemia and worsen cognitive symptoms. Another study suggests that once vitamin B12 deficiency is established in subjects with food-bound malabsorption, 40 microg/d to 80 microg/d of oral crystalline vitamin B12 for 30 d does not reverse the biochemical signs of deficiency. Together, these studies provide further evidence that public health strategies are needed to improve vitamin B12 status in order to decrease the risk of deficiency and any potentially adverse interactions with folic acid. PMID:17972439
Z.A. Wadood Khan
Full Text Available Vitamin B12 deficiency causes pancytopenia and also is also assocciated with platelet dysfunction. We report the case of a 17-year-old girl, who presented with fatigue and sudden painless, non-progressive loss of vision in the left eye. An ophthalmologic evaluation revealed bilateral subhyaloid haemorrhage, with macular involvement on the left eye. Earlier Bone marrow aspiration and biopsy were suggestive of partially treated vitamin B12 deficiency with pancytopenia. The patient had received four doses of vitamin B12 injections. She was given a complete course of vitamin B12 injections. Both the pancytopenia and subhyaloid haemorrhage improved completely with restoration of normal vision. This case documents the rare occurrence of subhyaloid haemorrhage in vitamin B12 deficiency.
Mohamad Reza Najafi
Full Text Available Background: Vitamin B 12 (Cobalamin deficiency can result in some clinical and paraclinical characteristics similar to what is seen in multiple sclerosis (MS patients. This study aimed to evaluate the controversial association between vitamin B 12 deficiency and MS. Methods: We measured serum vitamin B 12 in 60 patients with MS and 38 healthy controls. Clinical disability was evaluated according to the Extended Disability Status Scale (EDSS. Serum B 12 concentration was measured with Radioimmunoassay Dual Isotope method. The cutoff value for low serum vitamin B 12 concentrations was 75 pg/mL. Patients were in remission at the time of blood draw. Results: There were 13 (21.6% MS patients and 10 (26.3% controls with low serum B 12 concentration with no significant difference between the groups; P>0.05. The mean serum vitamin B 12 concentration in MS patients (108.9±45.3 pg/mL was not significantly different compared with controls (98.9±44.4 pg/mL; P=0.284. Likewise, there was no correlation between the concentration of serum vitamin B 12 and disease′ age of onset, duration, subtypes, or disability status. Conclusions: In contrast to some previous reports, our findings did not support any association between B 12 deficiency and MS.
Wiersinga, W J; de Rooij, S E J A; Huijmans, J G M; Fischer, C; Hoekstra, Joost B. L.
Vitamin B12 (cobalamin) deficiency is a common disorder with potential irreversible haematological and neurological consequences. Currently used diagnostic tests such as the evaluation of serum vitamin B12 and the Schilling test are insufficient, e.g. the positive predictive value of a low serum vit
Severe vitamin B12 deficiency produces a cluster of neurological symptoms in infants, including irritability, failure to thrive, apathy, anorexia, and developmental regression, which respond remarkably rapidly to supplementation. The underlying mechanisms may involve delayed myelination or demyelina...
Vitamin B12 deficiency usually presents with pernicious anemia or various neuropsychiatric manifestations. Commonly seen neuropsychiatric manifestations include large fiber neuropathy, myelopathy (subacute combined degeneration of the spinal cord), dementia, cerebellar ataxia, optic atrophy, psychosis and mood disorders. The present report highlights an unusual presentation of vitamin B12 deficiency- acute onset extrapyramidal syndrome in a 55-year-old man. The patient presented with a 10-day...
van Amsterdam JGC; Opperhuizen A; Jansen EHJM; TOX
The Dutch authorities consider fortifying certain foods with folic acid. Folic acid supplementation may, however, mask vitamin B12 deficiency and increase the incidence of peripheral neuropathy. This literature review outlines published studies to the potential masking of vitamin B12 deficiency related pernicious anaemia by folic acid. aggravate neurological manifestations comes from publications in the mid-1940s, when folic acid was first used to treat patients with pernicious anaemia. This ...
Black, Maureen M.
Folate deficiency in the periconceptional period contributes to neural tube defects; deficits in vitamin B12 (cobalamin) have negative consequences on the developing brain during infancy; and deficits of both vitamins are associated with a greater risk of depression during adulthood. This review examines two mechanisms linking folate and vitamin B12 deficiency to abnormal behavior and development in infants: disruptions to myelination and inflammatory processes. Future investigations should f...
Singh, A.K.; Kumar, A.; D Karmakar; R K Jha
Context: Long-term metformin use has been hypothesized to cause B12 deficiency and neuropathy in Type 2 diabetes patients. However, there is a paucity of Indian data regarding the same. Aim: To compare the prevalence of B12 deficiency and peripheral neuropathy in patients with Type 2 diabetes mellitus treated with or without metformin. Materials and Methods: We recruited patients with Type 2 diabetes and divided them into metformin exposed and nonmetformin exposed groups. We measured baseline...
Luiz Felipe Rocha Vasconcellos
Full Text Available As manifestações neurológicas associadas à deficiência de vitamina B12 incluem polineuropatia, mielopatia, demência e neuropatia óptica. O diagnóstico laboratorial é feito através da dosagem sérica de cianocobalamina ou homocisteína e da excreção urinária de ácido metilmalônico. No estudo anatomopatológico observa-se na microscopia a destruição da mielina e de axônios vistos na substância branca. A região mais comumente afetada é o cordão posterior cervical e/ou torácico. O acometimento da coluna lateral é raro, ocorrendo em casos graves e avançados. O tratamento consiste na reposição de vitamina B12 e a resposta depende da gravidade do quadro e do tempo transcorrido entre o inicio dos sintomas e inicio do tratamento. Relatamos o caso de um paciente que apresentou, como manifestação de deficiência de vitamina B12, mielite transversa. O estudo morfológico da medula demonstrou comprometimento dos tractos cortico-espinhais lateral e anterior, da coluna dorsal e ainda do tracto espino-talâmico.Vitamin B12 deficiency may induce neuropathy, myelopathy, dementia and optic neuropathy. The diagnosis is established by vitamin B12, homocysteine and methylmalonic acid measurements. Myelin and axon destruction in the white matter of the spinal cord are observed. The posterior column of the cervical and thoracic level is the most common involved area. The involvement of the anterior column is restricted to advanced and relatively severe cases. Treatment is based on vitamin B12 injections, and the prognosis depends on the stage of vitamin deficiency and deterioration at treatment onset. We report a case with transverse myelitis due to vitamin B12 deficiency. This picture is relatively uncommon, however, we believe patients with transverse myelitis should have vitamin B12 studies as part of the diagnosis work up.
MOLLOY, ANNE MARIE; SCOTT, JOHN MARTIN
PUBLISHED Background: Impaired vitamin B12 function and decreased vitamin B12 status have been associated with neurological and cognitive impairment. Current assays analyze total vitamin B12 concentration, only a small percentage of which is metabolically active. Concentrations of this active component, carried on holotranscobalamin (holoTC), may be of greater relevance than total vitamin B12. Methods: We compared the utility of serum holoTC with conventional vitamin B12 for detection ...
Full Text Available INTRODUÇÃO: A vitamina B12 é hidrossolúvel, não-sintetizada pelo organismo humano, presente em alimentos de origem animal. Sua deficiência é muito freqüente entre idosos, vegetarianos e indivíduos que adotam baixa dieta protéica ou apresentam problemas de absorção gastrintestinal. FISIOPATOLOGIA: A deficiência de vitamina B12 leva a transtornos hematológicos, neurológicos e cardiovasculares, principalmente, por interferir no metabolismo da homocisteína (Hcy e nas reações de metilação do organismo. Muitas vezes a deficiência pode permanecer assintomática por longos períodos, desencadeando uma deficiência crônica que, se mantida, pode levar a manifestações neurológicas irreversíveis. METODOLOGIAS: Metodologias eficientes que permitam um diagnóstico precoce são imprescindíveis. Porém um método considerado padrão-ouro ainda não é consensual. A dosagem sérica de vitamina B12 sofre algumas restrições pelos problemas de sensibilidade e especificidade, podendo ocorrer sintomas de deficiência mesmo com vitamina B12 sérica dentro dos níveis normais ou, de outro modo, ocorrendo baixos níveis de vitamina B12 sérica sem, contudo, apresentar baixos níveis da fração de vitamina realmente disponível para as células e sem apresentar sintomatologia. Novas alternativas vêm surgindo, como a dosagem de transcobalamina II (Tc II, a única fração de vitamina B12 disponível para as células, ou a dosagem de ácido metilmalônico (MMA e Hcy, metabólitos que aumentam quando ocorre diminuição de vitamina B12 intracelular. Estes testes apresentam algumas vantagens, mas também limitações importantes para uso rotineiro. CONCLUSÃO: Em casos subclínicos, um diagnóstico correto e precoce representa ainda um desafio, e futuros estudos são necessários para definir um método padrão para diagnóstico laboratorial da deficiência de vitamina B12.INTRODUCTION: The vitamin B12 is a water soluble vitamin, not
Mohammed Morad; Mark Gringols; Isack Kandel; Joav Merrick
The goal of this study was to determine the prevalence of vitamin B12 deficiency among intellectually disabled persons in a vegetarian remedial community in Israel. In this community, 47 individuals with intellectual disability (ID) live in 7 enlarged families in a kibbutz style agricultural setting. These 47 individuals and 17 of their caregivers were screened for vitamin B12 deficiency. There were 25.5% of the disabled vs. 11.8% of the caregivers found to have levels of vitamin B12 lower th...
Kocaoglu, Celebi; Akin, Fatih; Caksen, Hüseyin; Böke, Saltuk Buğra; Arslan, Sükrü; Aygün, Serhat
In developed countries, vitamin B12 (cobalamin) deficiency usually occurs in children, exclusively breastfed ones whose mothers are vegetarian, causing low body stores of vitamin B12. The haematologic manifestation of vitamin B12 deficiency is pernicious anaemia. It is a megaloblastic anaemia with high mean corpuscular volume and typical morphological features, such as hyperlobulation of the nuclei of the granulocytes. In advanced cases, neutropaenia and thrombocytopaenia can occur, simulating aplastic anaemia or leukaemia. In addition to haematological symptoms, infants may experience weakness, fatigue, failure to thrive, and irritability. Other common findings include pallor, glossitis, vomiting, diarrhoea, and icterus. Neurological symptoms may affect the central nervous system and, in severe cases, rarely cause brain atrophy. Here, we report an interesting case, a 12-month old infant, who was admitted with neurological symptoms and diagnosed with vitamin B12 deficiency. PMID:25076673
Full Text Available Introduction: Diabetes mellitus has its deleterious effects on various aspects of cognition such as memory function, executive function, and information-processing speed. The present study aims to assess cognition in diabetes patients and also tries to find its association with Vitamin B12 deficiency induced by metformin. Materials and Methods: Thirty diabetics taking metformin and thirty nondiabetic controls were enrolled. Event-related potentials (ERPs and serum Vitamin B12 levels were evaluated in them. Results: Vitamin B12 levels were found to be deficient, and latencies of waves P200 and P300 were prolonged in the diabetics as compared to the controls. The dose and duration of metformin had no association with the ERPs. Conclusions: Although the Vitamin B12 levels were deficient in diabetics on metformin, this is not the reason behind the cognitive impairment found in them.
Full Text Available The goal of this study was to determine the prevalence of vitamin B12 deficiency among intellectually disabled persons in a vegetarian remedial community in Israel. In this community, 47 individuals with intellectual disability (ID live in 7 enlarged families in a kibbutz style agricultural setting. These 47 individuals and 17 of their caregivers were screened for vitamin B12 deficiency. There were 25.5% of the disabled vs. 11.8% of the caregivers found to have levels of vitamin B12 lower than 157 pg/ml. It is concluded that persons with ID in this vegetarian residential care community seemed to be at a higher risk for vitamin B12 deficiency.
Human deficiencies of folate and vitamin B12 result in adverse effects which may be of public health significance, but the magnitude of these deficiencies is unknown. Therefore, we examine the prevalence data currently available, assess global coverage of surveys, determine the frequency with which...
Johnsen, J B; Fønnebø, V
Nine persons in the county of Troms, Norway, were interviewed on their strict vegetarian diet. Improved health was indicated as the main reason for their choice of diet, but religion was a contributing reason for some. Most of the study persons would increase the intake of vitamin B12 if a deficiency state were to occur. One person reported, however, that she would not regard vitamin B12 deficiency as a health problem. The interviews disclosed beliefs regarding human physiology that are very far removed from standard scientific knowledge. The article indicates that communication between patient and the health care system may be difficult in such circumstances. Problems of communication would probably be minimized if the patient had a thorough understanding of human physiology and the health worker a thorough understanding of the reasons for the patient's choice of diet. PMID:2000592
Full Text Available Introduction: Vitamin B12 deficiency occurs frequently among elderly patients and it has recently been connected with the occurrence of depressive symptoms in this population. The aim of this study was to determine the frequency of vitamin B12 deficiency among elderly patients from Eastern Croatia and to evaluate whether there is a connection between this deficiency and the occurrence of depressive symptoms among them.Methods: This cross-sectional study was conducted from April to June 2013, among 140 elderly patients from Vukovar-Srijem County (47.9%, 67/140 males and 52.1%, 73/140 females; mean age 71.0±6.7 years. The anonymous questionnaire was used to obtain demographic data, data regarding socio-economic status and personal history of diseases of study participants as well as data pertaining to the existence of depressive symptoms among them. The competitive immunoassay vitamin B12 kit was used to determine serum levels of vitamin B12.Results: Among all study participants there were 7.1% (10/140 of them with B12 deficiency and 70.0% (98/140 of them with the symptoms of depression. Depressive symptoms occurred in 100.0% (10/10 patients with the vitamin B12 deficiency and 67.7% (88/130 of patients without it.Conclusion: The study showed positive connection between the existence of depressive symptoms and vitamin B12 deficiency among elderly patients. This finding points to the need for frequent vitamin status evaluation in this age group and its consequent correction that could improve overall health of this population subgroup.
McMahon, Gearoid M; Hwang, Shih-Jen; Tanner, Rikki M.; Jacques, Paul F.; Selhub, Jacob; Muntner, Paul; Fox, Caroline S
Background: Variants in CUBN, the gene encoding cubilin, a proximal tubular transport protein, have been associated with albuminuria and vitamin B12 (B12) deficiency. We hypothesized that low levels of B12 would be associated with albuminuria in a population-based cohort. Methods: We analyzed participants from the Framingham Heart Study (n = 2965, mean age 58 years, 53% female) who provided samples for plasma B12. Logistic regression models adjusted for covariates including homocysteine were ...
El-Shafie, Kawther; Samir, Nafisa; Lakhtakia, Ritu; Davidson, Robin; Al-Waili, Ahmed; Al-Mamary, Muna; Al-Shafee, Mohammed
Vitamin B12 deficiency is common in developing countries and should be suspected in patients with unexplained anaemia or neurological symptoms. Dermatological manifestations associated with this deficiency include skin hyper- or hypopigmentation, angular stomatitis and hair changes. We report a case of a 28-year-old man who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in November 2013 with localised hyperpigmentation of the palmar and dorsal aspects of both hands of two months' duration. Other symptoms included numbness of the hands, anorexia, weight loss, dizziness, fatigability and a sore mouth and tongue. There was no evidence of hypocortisolaemia and a literature search revealed a possible B12 deficiency. The patient had low serum B12 levels and megaloblastic anaemia. An intrinsic factor antibody test was negative. A gastric biopsy revealed chronic gastritis. After B12 supplementation, the patient's symptoms resolved. Family physicians should familiarise themselves with atypical presentations of B12 deficiency. Many symptoms of this deficiency are reversible if detected and treated early. PMID:26357561
Full Text Available Vitamin B12 deficiency is common in developing countries and should be suspected in patients with unexplained anaemia or neurological symptoms. Dermatological manifestations associated with this deficiency include skin hyper- or hypopigmentation, angular stomatitis and hair changes. We report a case of a 28-year-old man who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in November 2013 with localised hyperpigmentation of the palmar and dorsal aspects of both hands of two months’ duration. Other symptoms included numbness of the hands, anorexia, weight loss, dizziness, fatigability and a sore mouth and tongue. There was no evidence of hypocortisolaemia and a literature search revealed a possible B12 deficiency. The patient had low serum B12 levels and megaloblastic anaemia. An intrinsic factor antibody test was negative. A gastric biopsy revealed chronic gastritis. After B12 supplementation, the patient’s symptoms resolved. Family physicians should familiarise themselves with atypical presentations of B12 deficiency. Many symptoms of this deficiency are reversible if detected and treated early.
Full Text Available We undertook a study 25 patients, all clinically suspected to have vitamin B12 deficiency; they were investigated hematologically, biochemically, & by gastric biopsy and MRI. Most of the patients were more than 40 years of age, were either vegetarian or non-vegetarian; 21 patients were belonging to the middle-income group. The total number of males in the study was 22 and there were three females. The clinical features of vitamin B12 deficiency are described. Clinical evidence of pyramidal tract involvement was found in six patients (24%. MRI confirmed cord involvement in 12 of the 17 patients (70.5%: follow up MRI of two patients showed marked reductions in signals after one year of treatment. These patients showed improvement after receiving injectable vitamin b12. Nerve conduction studies (N.C.V showed evidence of neuropathy in fifteen of eighteen (83% patients. Gastric biopsy was abnormal in all except one in the 20 patients in whom it was conducted. Anti intrinsic factor blocking antibodies (AIFBA were elevated in 11/24 (45.8% and anti parietal cell antibodies (APCAB were elevated in 19/24 patients (79%. The possible etiological factors responsible for vitamin B12 deficiency are age and pernicious anemia. As concluded in this study, diet was not found to be a contributory factor in the causation of cobalamin deficiency. We conclude that pernicious anemia is probably an important etiological factor as a cause of vitamin B12 deficiency in Indians. The male predominance is intriguing.
Watson, Emma; Olin-Sandoval, Viridiana; Hoy, Michael J; Li, Chi-Hua; Louisse, Timo; Yao, Victoria; Mori, Akihiro; Holdorf, Amy D; Troyanskaya, Olga G; Ralser, Markus; Walhout, Albertha Jm
Metabolic network rewiring is the rerouting of metabolism through the use of alternate enzymes to adjust pathway flux and accomplish specific anabolic or catabolic objectives. Here, we report the first characterization of two parallel pathways for the breakdown of the short chain fatty acid propionate in Caenorhabditis elegans. Using genetic interaction mapping, gene co-expression analysis, pathway intermediate quantification and carbon tracing, we uncover a vitamin B12-independent propionate breakdown shunt that is transcriptionally activated on vitamin B12 deficient diets, or under genetic conditions mimicking the human diseases propionic- and methylmalonic acidemia, in which the canonical B12-dependent propionate breakdown pathway is blocked. Our study presents the first example of transcriptional vitamin-directed metabolic network rewiring to promote survival under vitamin deficiency. The ability to reroute propionate breakdown according to B12 availability may provide C. elegans with metabolic plasticity and thus a selective advantage on different diets in the wild. PMID:27383050
Ritesh Kumar Agrawala
Full Text Available A 35-year-female presented with generalized weakness, weight loss, and progressive pigmentation was worked up for suspicion of Addisons disease. On examination hyper pigmentation was noted on both palmar and dorsal aspect of hands involving knuckles, creases, feet, tongue, oral mucosa and gluteal region. There was no evidence of hypocortisolemia as initially suspected, and literature search revealed a possibility of vitamin B12 deficiency. She had megaloblastic anemia with a low serum vitamin B12, mostly due to poor dietary intake. Her hyper pigmentation resolved with vitamin B12 supplementation. Skin biopsy showed increased pigmentation at stratum spinosum and basal-layer. The mechanism of hyper pigmentation in vitamin B12 deficiency was due to an increase in melanin synthesis.
Kibirige, Davis; Mwebaze, Raymond
Vitamin B12 is an essential micronutrient required for optimal hemopoetic, neuro-cognitive and cardiovascular function. Biochemical and clinical vitamin B12 deficiency has been demonstrated to be highly prevalent among patients with type 1 and type 2 diabetes mellitus. It presents with diverse clinical manifestations ranging from impaired memory, dementia, delirium, peripheral neuropathy, sub acute combined degeneration of the spinal cord, megaloblastic anemia and pancytopenia. This review ar...
Gupta, Anil K.; Damji, Alkarim; Uppaluri, Aparna
OBJECTIVE: To estimate the prevalence of vitamin B12 deficiency in adult South Asian patients. DESIGN: Retrospective chart review. SETTING: Family practice clinic in Toronto, Ont. PARTICIPANTS: Records of 988 South Asian patients. INTERVENTION: Of 1000 randomly selected records, we found 988 charts. From charts with at least one documented B12 level, we extracted data on age, mean corpuscular volume (MCV), hemoglobin and ferritin levels, and diet (if available). Descriptive and analytic stati...
Deepti Khattar; Farah Khaliq; Neelam Vaney; Madhu, S.V.
Introduction: Diabetes mellitus has its deleterious effects on various aspects of cognition such as memory function, executive function, and information-processing speed. The present study aims to assess cognition in diabetes patients and also tries to find its association with Vitamin B12 deficiency induced by metformin. Materials and Methods: Thirty diabetics taking metformin and thirty nondiabetic controls were enrolled. Event-related potentials (ERPs) and serum Vitamin B12 levels were eva...
Değirmenci, Yıldız; Örs, Ceyda Hayretdağ; Yılmaz, Yeliz; Karaman, Handan Işın Özışık
Objective: Aim of this study was to investigate the possible relationship between serum vitamin B12 levels and P100 latency and amplitudes with visual evoked potentials (VEP) in patients with B12 vitamin deficiency without optic neuritis (ON). Material and Methods: Patients who presented to the outpatient neurology clinic of Çanakkale Onsekiz Mart University Research Hospital underwent initial evaluation. Among those, complete blood count, full biochemistry (blood glucose, liver and kidne...
Wadia R S; Edul N C; Bhagat S; Bandishti S; Kulkarni R; Sontakke S; Barhadi S; Shah M
Hyperhomocysteinemia is a recognised risk factor for stroke and ischemic heart disease (HID). Vit B12 Folate and pyridoxine deficiency are important causes of raised serum homocysteine. As a vegetarian diet is very poor in Vit B12 we sought to study the incidence of hyperhomocysteinaemia in our stroke populating and to measure Vit B12 and folate in these cases. Consecutive cases of ischaemic stroke, either arterial or venous, admitted over a period of 2 1/2 years were studied. Embolic strokes...
Yetgin, Sevgi; Derman, Orhan; Dogan, Muhsin
Pseudotumor cerebri is a syndrome of increased intracranial pressure, normal cerebrospinal fluid values, and a normal cerebral ventricles on brain imaging studies. A patient with a diagnosis of pseudotumor cerebri was admitted to the authors' hospital twice within a 2.5-year interval and treated with vitamin B12 (vit-B12). At the second admission she also presented with a cerebral venous thrombosis that might have been explained by vit-B12 deficiency, homocysteinemia, and an increased level of lipoprotein-a. PMID:16326411
Goraya, Jatinder Singh; Kaur, Sukhjot; Mehra, Bharat
We studied 27 infants aged 6 to 27 months with vitamin B12 deficiency also known as "infantile tremor syndrome" in India. All were exclusively breast-fed by vegetarian mothers. Developmental delay or regression, pallor, skin hyperpigmentation, and sparse brown hair were present in all. Majority were hypotonic and involuntary movements were encountered in 18. Anemia and macrocytosis was found in 83% and 71% infants, respectively. Low serum vitamin B12 was present in 12 of 21 infants. Seven of the 9 infants with normal serum vitamin B12 had received vitamin B12 before referral. Twelve mothers had low serum vitamin B12. Cerebral atrophy was present in all the 9 infants who underwent neuroimaging. Treatment with vitamin B12 resulted in dramatic improvement in general activity and appetite within 48 to 72 hours followed by return of lost milestones. Tremors resolved in all by 3 to 4 weeks. Nutritional vitamin B12 deficiency is a treatable cause of neurologic dysfunction in infants. PMID:25953825
Full Text Available Background: The elderly population is particularly at risk for developing vitamin B12-deficiency. Serum cobalamin does not necessarily reflect a normal B12 status. The determination of methylmalonic acid is not available in all laboratories. Issues of sensitivity for holotranscobalamin and the low specificity of total homocysteine limit their utility. The aim of the present study is to establish a diagnostic algorithm by using a combination of these markers in place of a single measurement. Methods: We compared the diagnostic efficiency of these markers for detection of vitamin B12 deficiency in a population (n = 218 of institutionalized elderly (median age 80 years. Biochemical, haematological and morphological data were used to categorize people with or without vitamin B12 deficiency. Results: In receiver operating curves characteristics for detection on vitamin B12 deficiency using single measurements, serum folate has the greatest area under the curve (0.87 and homocysteine the lowest (0.67. The best specificity was observed for erythrocyte folate and methylmalonic acid (100% for both but their sensitivity was very low (17% and 53%, respectively. The highest sensitivity was observed for homocysteine (81% and serum folate (74%. When we combined these markers, starting with serum and erythrocyte folate, followed by holotranscobalamin and ending by methylmalonic acid measurements, the overall sensitivity and specificity of the algorithm were 100% and 90%, respectively. Conclusion: The proposed algorithm, which combines erythrocyte folate, serum folate, holotranscobalamin and methylmalonic acid, but eliminate B12 and tHcy measurements, is a useful alternative for vitamin B12 deficiency screening in an elderly institutionalized cohort.
Full Text Available Coβ-4-ethylphenyl-cob(III alamin (EtPhCbl is an organometallic analogue of vitamin B12 (CNCbl which binds to transcobalamin (TC, a plasma protein that facilitates the cellular uptake of cobalamin (Cbl. In vitro assays with key enzymes do not convert EtPhCbl to the active coenzyme forms of Cbl suggesting that administration of EtPhCbl may cause cellular Cbl deficiency. Here, we investigate the in vivo effect of EtPhCbl in mice and its ability, if any, to induce Cbl deficiency. We show that EtPhCbl binds to mouse TC and we examined mice that received 3.5 nmol/24h EtPhCbl (n=6, 3.5 nmol/24h CNCbl (n=7 or NaCl (control group (n=5 through osmotic mini-pumps for four weeks. We analyzed plasma, urine, liver, spleen, submaxillary glands and spinal cord for Cbl and markers of Cbl deficiency including methylmalonic acid (MMA and homocysteine (tHcy. Plasma MMA (mean±SEM was elevated in animals treated with EtPhCbl (1.01±0.12 µmol/L compared to controls (0.30±0.02 µmol/L and CNCbl (0.29±0.01 µmol/L treated animals. The same pattern was observed for tHcy. Plasma total Cbl concentration was higher in animals treated with EtPhCbl (128.82±1.87 nmol/L than in CNCbl treated animals (87.64±0.93 nmol/L. However, the organ levels of total Cbl were significantly lower in animals treated with EtPhCbl compared to CNCbl treated animals or controls, notably in the liver (157.07±8.56 pmol/g vs. 603.85±20.02 pmol/g, and 443.09±12.32 pmol/g, respectively. Differences between the three groups was analysed using one-way ANOVA and, Bonferroni post-hoc test. EtPhCbl was present in all tissues, except the spinal cord, accounting for 35-90% of total Cbl. In conclusion, treatment with EtPhCbl induces biochemical evidence of Cbl deficiency. This may in part be caused by a compromised tissue accumulation of Cbl.
Suleyman Yuce; Medine Cumhur Cure; Erkan Cure; Sefa Kiztanir; Abdulkadir Basturk; Hasan Efe
Purpose: Megaloblastic anemia due to vitamin B12 deficiency is common in the population. Vitamin B12 therapy may stimulate all cell types in the bone marrow. We investigated whether young, active and large platelets are released into the peripheral blood during vitamin B12 treatment and measured the level of mean platelet volume (MPV), an indicator of the presence of these platelets. Materials and Methods: A total of 204 patients (40 males, 160 females) with vitamin B12 deficiency were in...
Kitamura, Taisuke; Gotoh, Seiji; Takaki, Hayato; Kiyuna, Fumi; Yoshimura, Sohei; Fujii, Kenichiro
An 86-year-old woman with a one-year history of dementia was admitted to our hospital complaining of loss of appetite, hallucinations, and disturbance of consciousness. She gradually presented with chorea-like involuntary movements of the extremities. Diffusion-weighted magnetic resonance imaging (MRI) showed bilateral symmetrical hyperintense signals in the basal ganglia. The serum vitamin B12 level was below the lower detection limit of 50 pg/ml. The homocysteine level was markedly elevated at 115.8 nmol/ml. Anti-intrinsic factor and anti-parietal cell antibody tests were positive. Gastrointestinal endoscopy revealed atrophic gastritis. The patient was diagnosed with encephalopathy due to vitamin B12 deficiency caused by pernicious anemia. Involuntary movements and MRI abnormalities improved with parenteral vitamin B12 supplementation. Bilateral basal ganglia lesions are rare manifestations of adult vitamin B12 deficiency. The present case is considered valuable in identifying the pathophysiology of involuntary movement due to vitamin B12 deficiency. PMID:27356735
Güneş, Ali; Aktar, Fesih; Tan, İlhan; Söker, Murat; Uluca, Ünal; Balık, Hasan; Mete, Nuriye
The aim of this study was to investigate urine early kidney injury molecules, including human kidney injury molecule-1 (KIM-1), liver-type fatty-acid binding protein (L-FABP), N-acetyl-b-D-glucosaminidase A (NAG), and neutrophil gelatinase-associated lipocalin (NGAL) in children with vitamin B12 (cobalamin) deficiency (CD). Twelve children with vitamin B12 deficiency and 20 healthy matched controls were included. Hematologic parameters, serum urea, creatinine (Cr), electrolytes, B12 and folate levels were recorded. Estimated glomerular filtration rate (eGFR) was calculated. Urine protein, electrolytes, andurinary early markers were measured. Patients with CD had significantly higher urine electrolyte/Cr ratios (p L-FABP/Cr, NAG/Cr and NGAL/Cr were found in CD group (p <0.05). Significant negative correlations were found between levels of serum B12 and urinary markers in the patients (p <0.05). Increased urinary kidney injury molecules and electrolytes in children with B12 deficiency suggest a possible subclinical renal dysfunction, which cannot be determined by conventional kidney function tests. PMID:27606644
Thomas Gregor Issac
Full Text Available Background: Vitamin B12 deficiency is a common condition causing neurologic, cognitive, psychiatric, and mood symptoms. With varied religious, ethnic, and socioeconomic heterogeneity among the people in India greatly influencing their dietary habits and with the high prevalence of Helicobacter pylori infection, Vitamin B12 deficiency is not uncommon, but is often under recognized due to the lack of classical symptomatic presentation. Materials and Methods: Retrospective study on Vitamin B12 deficiency with neuropsychiatric symptoms in patients who attended neurology, psychiatry, and geriatric OPDs for a period of 1 year in a specialized neuropsychiatric institute in South India. Results: Out of 259 patients who had Vitamin B12 deficiency (<220 pmol/L, 60 had neuropsychiatric symptoms. Among them the Vitamin B12 levels were <150 (severe, 150-200 (moderate, and 201-220 pmol/L (mild in 19, 24, 17 patients, respectively. Twenty one were diagnosed with Posterior dementias, 20 with frontotemporal dementia, 7 with Schizophrenia, 4 each with Parkinson′s disease and alcohol-dependent syndromes (ADS, 3 with bipolar affective disorder, and 1 with Creutzfeldt-Jakob disease. Eight patients also had hypothyroidism. First symptom of presentation was behavioral disturbances in 30 (50%, memory loss in 20 (33.9%, and sensorimotor and movement disorders in 9 (15.3%, and 56.7% were vegetarians while 43.3% were nonvegetarians. In our study, Vitamin B12 deficiency was more prevalent in elderly males (56.67% and was associated with increased severity of behavioral disturbances (P = 0.043 which was the most common presentation. Memory loss was present in 16 (84.2% patients of severe Vitamin B12 deficiency. Hindi mental status examination (HMSE score was graded as <20, 20-24, 24-31 in 37 (61.7%, 10 (16.7%, and 13 (21.7% patients, respectively. Cognitive decline in Vitamin B12 deficiency was significantly associated with increased serum cholesterol (P = 0.019 and was
Kawther El-Shafie; Nafisa Samir; Ritu Lakhtakia; Robin Davidson; Ahmed Al-Waili; Muna Al-Mamary; Mohammed Al-Shafee
Vitamin B12 deficiency is common in developing countries and should be suspected in patients with unexplained anaemia or neurological symptoms. Dermatological manifestations associated with this deficiency include skin hyper- or hypopigmentation, angular stomatitis and hair changes. We report a case of a 28-year-old man who presented to the Sultan Qaboos University Hospital in Muscat, Oman, in November 2013 with localised hyperpigmentation of the palmar and dorsal aspects of both hands of two...
Malhotra, Savita; Subodh, B. N.; Parakh, Preeti; Lahariya, Sanjay
Childhood disintegrative disorder is a rare disorder, characterized by regression of acquired skills after a period of normal development. The case of childhood disintegrative disorder presented here was found to have vitamin B12 deficiency and hyperhomocysteinemia on extensive evaluation to find a probable cause for regression. This case…
P. R. Kamchatnov
Full Text Available Vitamin metabolic disorders can cause diverse dysfunctions of both the peripheral and central nervous systems. There is conclusive evidence that cyanocobalamin (vitamin B12 and folic acid deficiencies may lead to diminished cognitive functions even to the extent of developing dementia. Cognitive impairments may be accompanied by involvement of other regions of the central nervous system, the corticospinal tract in particular, less frequently by brainstem and cerebellar disorders. Changes in nervous system functions in the presence of cyanocobalamin deficiency may predominate in the clinical picture, ahead of the occurrence of hematological changes. The paper considers the possible mechanisms for involvement of brain neurons in deficiency of cyanocobalamin and in that of folic acid in particular in patients with hyperhomocysteinemia. The low serum concentration of folic acid or cyanocobalamin in the elderly raises the risk of developing Alzheimer’s disease in future (by almost twice and vascular dementia. The authors give the results of randomized clinical trials evaluating the efficacy of the vitamins used in patients with cognitive impairments. Thus, there are data that the use of cyanocobalamin in patients with lacunar infarcts and moderate cognitive impairments may give rise to their complete recovery and reduce the risk of depressive disorders. Intramuscular cyanocobalamin used in a daily dose of 1000 μg for 5 days, then 1000 μg once monthly is demonstrated to be efficacious. This therapy may be effective in patients with different types of dementia and cognitive diminution, primarily in those with these conditions and its serum concentration of less 150 pmol/l. Among the side effects while taking folic acid, there may be higher incidence rates of convulsive attacks. A number of trials have shown the efficacy of cyanocobalamin, pyridoxine, and folic acid in preventing acute cerebral ischemic episodes; however, not all the investigations
Melike Sezgin Evim
Full Text Available Objective: Vitamin B12 deficiency is frequently observed in developing countries. Herein we report the long-term clinical and laboratory outcomes in 45 children presented with various symptoms of vitamin B12 deficiency.Materials and Methods: Symptoms and physical findings, and percentiles for weight, height, and head circumference at presentation were recorded. The educational level of the patients’ mothers, vitamin B12 deficiency-related diseases and family income data were collected. Complete blood count, serum vitamin B12, folate, iron, iron binding capacity and ferritin, and plasma homocysteine levels were recorded measured at presentation. The patients were treated with vitamin B12, as follows: 1 mg/d IM for 1 week, followed by 1 mg IM QWK for 2 weeks, and then monthly 1mg injections. Patients were neurologically and hematologically re-evaluated after treatment. The visual evoked potential (VEP test was used to examine the integrity and function of the visual pathway. Brainstem evoked potential (BAEP responses were used to analyze auditory function. Neuromotor development was assessed using Denver II Development Screening Test. Results: The mean age of 20 male and 25 female patients was 5.6±5.9 years (range: 1.4 months-17 years. The most common symptoms at presentation were weakness, failure to thrive, and hematologic manifestations (pallor, petechiae, ecchymosis. Abnormal neurologic findings at presentation were observed in 20% of the patients, and were more commonly observed in those <2 years. VEP, BAEP, and Denver II Development tests were performed in 66% of the patients one year after vitamin B12 replacement was started. VEP and BAEP interval prolongation was observed in 37% and 17% of the cases, respectively. Denver II Development Test results showed developmental delay in 20% of the patients tested.Conclusion: All the patients achieved full hematologic recovery within 1 month of treatment onset. Neurological symptoms resolved
Jarosz, Malgorzata; Irga, Ninela; Wierzba, Jolanta
Vitamin B(12) stores at birth are adequate for infants until the end of the first year of life even if it 's concentration in maternal breast milk is low. However, there are some situations in which infants have depleted vitamin B(12) stores and in addition have a low dietary intake of cobalamin. Vitamin B(12) depletion occurs in infants who are exclusively breastfed by mothers who have unrecognized pernicious anemia or are strict vegetarians for many years. In those infants symptoms of bone marrow disfunction and impaired development of the central nervous system appear already in the first months of life. Unrecognized cobalamin deficiency may lead to serious neurologic consequences, and even to the death of the child. The authors present a case of a 7.5 month old girl admitted to the Department of Paediatrics, Haematology, Oncology and Endocrinology. Gdańsk Medical University suspected of acute leukaemia. Based on a detailed diagnostic procedure a final diagnosis of vitamin B(12) deficiency anaemia was established. The child was exclusively breast-fed. Results of investigations into the reason for cobalamin deficiency in the patient s organism. Led to the diagnosis of pernicious anaemia in the mother. Such a suspicion had been made during pregnancy, but no continuation of investigations nor appropriate treatment were implemented. After treatment with vitamin B(12) supplements and modification of the diet the patient improved quickly and remarkably. A few months follow-up was enough to observe remarkable improvement of psychomotor development of this child. PMID:15738604
Full Text Available Vitamin B12 plays an important role in building of genetic material, in development of normal red blood cells and in maintenance of nervous system. Major deficiency symptoms of Vitamin B12 include anemia and neurological disorders. The daily recommended intake of vitamin B12 for an adult is 1.5μg a day. Eating a diet containing required amount of vitamin B12 is the best way to treat the conditions associated with its low level. Vitamin B12 found only in animal based foods such as meats, liver, kidney, fish, eggs, milk and milk products, oysters and shellfish. Hence, vegetarians are more likely to have low level of Vitamin B12.
LACHNER, C.; MARTIN, C.; JOHN, D.; NEKKALAPU, S.; SASAN, A.; STEINLE, N.; REGENOLD, W.T.
Objective Vitamin B12 (B12) deficiency is most prevalent among older adults. Practice guidelines recommend screening older adults with symptoms of cognitive disorder for B12 deficiency. However, guidelines for non-cognitive psychiatric disorders typically do not mention screening older adults for B12 deficiency. The purpose of this study was to determine whether routine screening of older adult psychiatric inpatients for B12 deficiency, regardless of cognitive symptoms, is clinically justified. Design We conducted a retrospective chart-review study of consecutive inpatient admissions. Setting Older Adult Acute Psychiatric Inpatient Unit at the University of Maryland Medical Center from 10/2007-4/2010. Participants Acute psychiatric inpatients aged ≥50 years who met inclusion criteria (N=374). Measurements Mean (SD) B12 levels and percentages of probable (<180pg/mL) and possible (180–350pg/mL) B12 deficiency as well as characteristics of patients with probable and possible B12 deficiency compared to patients with optimal B12 levels. Results Mean (SD) B12 levels and percentages of probable and possible B12 deficiency, respectively, for cognitive disorder patients [468 (284) pg/mL, 7.8 % (n=5) and 29.7% (n=19)] and for non-cognitive disorder patients [481(268) pg/mL, 4.8 %(n=15) and 33.2%(n=103)] were not significantly different (t=0.339, df=372, P=0.735; χ2=1.084, df=2, P=0.582, respectively). Conclusion Considering the potential benefits and low costs of screening and treatment, we conclude that it is justified to routinely screen older adult psychiatric inpatients for B12 deficiency whether or not cognitive disorder symptoms are present. PMID:24522476
Mahajan, Sanket K.; Aundhakar, Swati C.
Context: This study summarizes the prevalence of vitamin B12 and folic acid deficiency in the population coming to tertiary care center in Western Maharashtra along with the main presenting symptom routinely misinterpreted in daily practice. Aims and Objectives: 1. To study the prevalence of vitamin B12 and folic acid deficiency in the population of western Maharashtra. 2. To correlate the symptoms with serum vitamin B12 and folic acid levels. Materials and Methods: The present study is a cro...
Aaron S; Kumar Sudhir; Vijayan J; Jacob J; Alexander M; Gnanamuthu C
AIMS AND OBJECTIVES: To study the clinical and laboratory features of patients admitted with vitamin B12 deficiency-related (B12def) neurological syndromes. SETTINGS AND DESIGN: A hospital-based retrospective and prospective study conducted at a referral teaching hospital. MATERIALS AND METHODS: Consecutive patients admitted with vitamin B12 deficiency-related neurological disorders during a three-year period from June 2000 to May 2003 were included. Data regarding clinical and laboratory fea...
Vitamin B12 deficiency is one of the common conditions in the elderly population leading to confusion, depression, memory loss and balance problems. Unfortunately there is no gold standard test for the diagnosis of cobalamin deficiency and a wide range of variation in reference levels according to country, and laboratory assay used. This poses a problem in diagnosing this condition making it a commonly misdiagnosed medical entity. There is current emphasis on need for clearer guidelines and much research is still being done to pave ways to determine better reference values for serum B12 and other screening tests. It is advised that screening methods are used adjunctively for the purpose of screening individuals. (author)
Wadia R S
Full Text Available Hyperhomocysteinemia is a recognised risk factor for stroke and ischemic heart disease (HID. Vit B12 Folate and pyridoxine deficiency are important causes of raised serum homocysteine. As a vegetarian diet is very poor in Vit B12 we sought to study the incidence of hyperhomocysteinaemia in our stroke populating and to measure Vit B12 and folate in these cases. Consecutive cases of ischaemic stroke, either arterial or venous, admitted over a period of 2 1/2 years were studied. Embolic strokes and those on vitamin supplements were excluded. cases were divided into vegetarian (including those taking milk and / Or eggs, those who took non-vegetarian 4 or less times a month, and frequent non-vegetarians taking 5 or more times a month. Serum total homocysteine, serum B12 and folate levels were studied along with all other routine parameters. For comparison we examined 101 controls without HID, stroke, peripheral vascular disease, rental failure or recent vitamin intake. With the international norm for homocysteine given as 5-15 umol/litre (1we called serum homocysteine 16 umol/litre or more as raised. There were 147 cases of ischcmic stroke :119 arterial and 28 venous infarcts. In the arterial strokes 99 of 119 cases (83.19% had raised serum Homocysteine including 25 of 27 (92.5% of those with arterial stroke before age 45. Of 28 cases with venous infarct 21 (75% had raised homocysteine (HCY. Hyperhomocysteinemia was the commonest risk factor for stroke in our populations. Out of the total 147 cases the exact dietary intake was not known for ten cases., 58 were vegetarians, 54 were occasional non vegetarians (NV and 25 were frequent NV. In the 58 vegetarians, 55 had serum HCY> 16 umol/1 (94.8% and of those vegetarians with HCY> 16, serum B12 <200pg/ml was seen in 44 (75.8% and between 200-300 pg/ml in five (8.6%. Of the 54 occasional NV, 46 had HCY>16umo/1 (85.2% Of those with HCY >16, serum B12 level of <200 pg/ ml was seen in 28 (51.85% occ. NV and
Pawlak, R; Lester, S E; Babatunde, T
Individuals following vegetarian diets are at risk for developing vitamin B12 deficiency owing to suboptimal intake. As vitamin B12 is essential for the synthesis of nucleic acids, erythrocytes and in the maintenance of myelin, deficiency may result in a variety of symptoms. Some of these symptoms may be severe while others may be irreversible. The objective of this review was to assess vitamin B12 deficiency, based on reported serum vitamin B12, among individuals adhering to different types of vegetarian diets. A systematic literature search was carried out using multiple search engines including PubMed, Medline, CINAHL plus, ERIC, Nursing and Allied Health Collection and Nursing/Academic Edition. The inclusion criteria consisted of original studies that assessed serum vitamin B12, studies written in English, non-case studies and studies that reported actual percentages of vitamin B12 deficiency. Forty research studies were included. The deficiency prevalence among infants reached 45%. The deficiency among the children and adolescents ranged from 0 to 33.3%. Deficiency among pregnant women ranged from 17 to 39%, dependent on the trimester. Adults and elderly individuals had a deficiency range of 0-86.5%. Higher deficiency prevalence was reported in vegans than in other vegetarians. Thus, with few exceptions, the reviewed studies documented relatively high deficiency prevalence among vegetarians. Vegans who do not ingest vitamin B12 supplements were found to be at especially high risk. Vegetarians, especially vegans, should give strong consideration to the use of vitamin B12 supplements to ensure adequate vitamin B12 intake. Vegetarians, regardless of the type of vegetarian diet they adhere to, should be screened for vitamin B12 deficiency. PMID:24667752
Luiz Felipe Rocha Vasconcellos; Rosalie Branco Corrêa; Leila Chimelli; Fernanda Nascimento; Adriane Baptista Fonseca; Janaina Nagel; Sergio Augusto Pereira Novis; Maurice Vincent
As manifestações neurológicas associadas à deficiência de vitamina B12 incluem polineuropatia, mielopatia, demência e neuropatia óptica. O diagnóstico laboratorial é feito através da dosagem sérica de cianocobalamina ou homocisteína e da excreção urinária de ácido metilmalônico. No estudo anatomopatológico observa-se na microscopia a destruição da mielina e de axônios vistos na substância branca. A região mais comumente afetada é o cordão posterior cervical e/ou torácico. O acometimento da co...
Mutti, Elena; Ruetz, Markus; Birn, Henrik;
Coβ-4-ethylphenyl-cob(III) alamin (EtPhCbl) is an organometallic analogue of vitamin B12 (CNCbl) which binds to transcobalamin (TC), a plasma protein that facilitates the cellular uptake of cobalamin (Cbl). In vitro assays with key enzymes do not convert EtPhCbl to the active coenzyme forms of Cbl...
P. R. Kamchatnov; I.V. Damulin
Vitamin metabolic disorders can cause diverse dysfunctions of both the peripheral and central nervous systems. There is conclusive evidence that cyanocobalamin (vitamin B12) and folic acid deficiencies may lead to diminished cognitive functions even to the extent of developing dementia. Cognitive impairments may be accompanied by involvement of other regions of the central nervous system, the corticospinal tract in particular, less frequently by brainstem and cerebellar disorders. Changes in ...
Tamura, J; Kubota, K; Murakami, H; Sawamura, M; Matsushima, T; Tamura, T; Saitoh, T; Kurabayshi, H; Naruse, T
It has been suggested that vitamin B12 (vit.B12) plays an important role in immune system regulation, but the details are still obscure. In order to examine the action of vit.B12 on cells of the human immune system, lymphocyte subpopulations and NK cell activity were evaluated in 11 patients with vit.B12 deficiency anaemia and in 13 control subjects. Decreases in the number of lymphocytes and CD8+ cells and in the proportion of CD4+ cells, an abnormally high CD4/CD8 ratio, and suppressed NK cell activity were noted in patients compared with control subjects. In all 11 patients and eight control subjects, these immune parameters were evaluated before and after methyl-B12 injection. The lymphocyte counts and number of CD8+ cells increased both in patients and in control subjects. The high CD4/CD8 ratio and suppressed NK cell activity were improved by methyl-B12 treatment. Augmentation of CD3-CD16+ cells occurred in patients after methyl-B12 treatment. In contrast, antibody-dependent cell-mediated cytotoxicity (ADCC) activity, lectin-stimulated lymphocyte blast formation, and serum levels of immunoglobulins were not changed by methyl-B12 treatment. These results indicate that vit.B12 might play an important role in cellular immunity, especially relativing to CD8+ cells and the NK cell system, which suggests effects on cytotoxic cells. We conclude that vit.B12 acts as an immunomodulator for cellular immunity. PMID:10209501
Shamkani, Warkaa Al; Jafar, Nagham Saeed; Narayanan, Sunil Roy; Rajappan, Anil Kumar
Hyper-homocysteinemia is a risk factor for coronary artery disease in young patients. A 32 years old female without any conventional risk factors except obesity presented with acute anterior wall myocardial infarction (MI). Her echocardiography showed anterior wall hypokinesia with moderate left ventricular dysfunction. Angiography showed tight stenosis of the proximal left anterior descending (LAD) and borderline lesion in left circumflex coronary artery (LCX). She underwent percutaneous coronary intervention (PCI) to LAD with good result. Her blood tests showed low vitamin B12, folate and serum iron levels and elevated serum homocysteine level. She was given folic acid and vitamin B12 and her homocysteine levels normalized. This case demonstrates that hyperhomocysteinemia caused by nutritional deficiency of vitamin co factors may lead to MI. Hyperhomocysteinemia should be considered in the evalauation of young people with MI, especially those without conventional risk factors. PMID:25838876
Full Text Available BACKGROUND: Adolescence is the formative period of life when the maximum amount of physical, psychological and behavioral changes takes place and this is a vulnerable period in the human life cycle for the development of nutritional anaemia, which has been constantly neglected by public health programs. The prevalence of anaemia is disproportionately high in developing countries than developed countries. It has mainly been ascribed to poverty, inadequate diet, certain diseases, pregnancy and lactation, and poor access to health services in developing countries Prevalence of anaemia in adolescents in India have been reported in limited studies available from 16.25% to 96.5%. Nutritional anaemia constitutes the most important cause of anaemia in adolescents. It is mainly due to deficiency of Iron, Vitamin B12 and Folate. Megaloblastic Anaemia resulting from deficiency of folate and B12 appears to be increasing over the last two decades. AIMS AND OBJECTIVES: 1.To study the types of nutritional anemia in adolescents (10-18 yrs. attending the hospital and correlate severity of nutritional anemia with serum levels of ferritin, Vit B12 & folate. 2. And also to determine demographic, socio-economic & nutritional factors for nutritional anemia in adolescents. STUDY DESIGN: A cross sectional study was conducted in selected sample of 200 subjects. SETTINGS: The study was conducted in the Department of General Medicine, Azeezia Medical College; during November 2011 to April 2013, as a cross-sectional observational study. MATERIALS AND METHODS: Subjects were selected based on the inclusion criteria set and evaluated with aid of laboratory investigation of blood samples collected from subjects. RESULTS AND CONCLUSION: Present study was undertaken to find out etiology and socio-demographic correlates of nutritional anaemia in adolescents. And it was found out that Folate deficiency was the most common followed by Vitamin B12 deficiency & then irons deficiency
Eussen, S.J.; Groot, de, H.L.F.; Joosten, L.W.; Bloo, R.; Clarke, R.; Ueland, P.M.; Schneede, J.; Blom, H. J.; Hoefnagels, W. H.; Staveren, van, W.A.
Background: Vitamin B-12 deficiency is associated with cognitive impairment in older people. However, evidence from randomized trials of the effects of vitamin B-12 supplementation on cognitive function is limited and inconclusive. Objective: The objective was to investigate whether daily supplementation with high doses of oral vitamin B-12 alone or in combination with folic acid has any beneficial effects on cognitive function in persons aged 70 y with mild vitamin B-12 deficiency. Design: I...
Gajudhur, Juyotee; Slone, Jeremy S; Mehta, Parth S; Mahoney, Donald
Vitamin B12 deficiency is a rare diagnosis in young children. We present the case of a 1-year-old Zimbabwean child with profound anemia. Further testing revealed undetectable levels of vitamin B12 and positive intrinsic factor antibodies that were drawn after the initiation of empiric treatment with parenteral vitamin B12. We report the evaluation and management of vitamin B12 deficiency in a resource-limited setting. Vitamin B12 deficiency should be considered in children presenting with unexplained cytopenias with consideration of empiric treatment with parenteral vitamin B12, as developmental and neurological complications of vitamin B12 deficiency can be devastating and permanent. PMID:27306229
Areekul, S; Roongpisuthipong, C; Churdchu, K; Thanomsak, W
A 19-year-old man presented with blurring of vision for 2 weeks. He also complained of anorexia with weight loss during the past 4 months. Eight years ago, his small bowel from midportion of the jejunum, ileum, ascending colon and transverse colon were resected because of gangrene. He gave no history of exposure to tobacco, alcohol or other toxins. The bone marrow aspiration showed hypocellular with panhypoplasia. Serum vitamin B12 level was low while serum and red cell folate were within normal limits. His visual acuity was 5/200 in both eyes with centrocecal scotomas in both eyes. Other neurologic and ophthalmic examinations were found to be normal. The patient was given intramuscular injections of 1,000 micrograms of cyanocobalamin. Four months later, his visual acuity improved, serum vitamin B12 level and the bone marrow returned to be normal. This is a frank case of optic neuropathy in a patient with vitamin B12 deficiency due to a massive small bowel resection. PMID:1308541
Lubana, Sandeep Singh; Alfishawy, Mostafa; Singh, Navdeep; Atkinson, Sharon
Patient: Male, 49 Final Diagnosis: Generalized tonic-clonic seizures in the setting of vitamin B12 deficiency and elevated folate levels Symptoms: Seizures Medication: — Clinical Procedure: None Specialty: Neurology Objective: Unknown ethiology Background: Vitamin B12 deficiency leads to abnormal myelination or demyelination, resulting in sub-acute combined degeneration, peripheral neuropathy, and psychiatric problems, including delusions, hallucinations, cognitive changes, depression, and de...
Folate and vitamin B12 deficiencies have been known to cause megaloblastic anaemia. Since the deficiencies of these two vitamins are very common in Pakistani population, it would be imperative to investigate their role in causing megaloblastic anaemia. The objective of this study was to find out the contribution of folate and vitamin B12 deficiencies in causing megaloblastic anaemia in our patient population. Methods: In this retrospective cohort study, clinical records of 220 patients (101 females and 119 males with an age range of 1 - 80 years) who presented themselves with macrocytic anaemia at the Aga Khan University Hospital were collected. Data pertaining to complete blood count and serum levels of folate and vitamin B12 were analysed. Results: The mean haemoglobin (Hb) level was 6.8 +- 0.2 gm/dl. Sixty-nine percent of the patients had severe anaemia (Hb<8 gm/dl). Mean +- SEM values of haemoglobin, serum folate and serum B12 were not significantly different between males and females (Hb 6.4 +- 0.3 gm/dl vs 6.3 +- 0.3 gm/dl; folate 6.9 +- 0.8 mu g/ml vs 7.8 +- 1 mu g/ml; B12 259 +- 65 mu g/ml vs 225 +- 45 mu g/ml, respectively). Linear regression analysis showed that serum folate was inversely related with the mean corpuscular volume (MCV, p=0.04). Spearman's correlation analysis indicated an inverse mild association between MCV and serum folate (correlation coefficient= -0.18). Folate deficiency was 43.4%, while vitamin B12 deficiency was 78.5% in these patients. Seventy-one percent of folate-deficient patients had vitamin B12 deficiency as well, while 26.1% of patients with B12 deficiency had a co-occurrence of folate deficiency. Conclusion: Vitamin B12 deficiency appears to be the major factor leading to megaloblastic anaemia in our study population. Inadequate dietary intake, over-cooking of our food and poor absorption might be contributing to high prevalence of vitamin B12 deficiency in this population. (author)
Vitamin B12 deficiency is a frequently considered diagnosis for which there is no single, commonly available and accurate test. A urinary methylmalonic acid assay using gas chromatography-mass spectrometry has been proposed as the preferred test. We reviewed vitamin B12 assays on 1599 consecutive patients and prospectively studied all patients with low serum B12 levels (n = 75) and a random sample of patients with normal levels (n = 68). Of 96 evaluable patients, 7 had clinical deficiency. All 7 deficient patients had urinary methylmalonic acid levels greater than 5 micrograms/mg creatine (sensitivity, 100%; confidence interval, 65% to 100%). Of the 89 patients who were not clinically deficient, 88 had urinary methylmalonic acid levels less than or equal to 5 micrograms/mg creatinine (specificity, 99%). The overall test accuracy in this population was 99%. If the high sensitivity and specificity of the gas chromatography-mass spectrometry assay for urinary methylmalonic acid is supported by other clinical studies, the methylmalonic acid assay may become the reference standard for the diagnosis of vitamin B12 deficiency
Full Text Available AIMS AND OBJECTIVES: To study the clinical and laboratory features of patients admitted with vitamin B12 deficiency-related (B12def neurological syndromes. SETTINGS AND DESIGN: A hospital-based retrospective and prospective study conducted at a referral teaching hospital. MATERIALS AND METHODS: Consecutive patients admitted with vitamin B12 deficiency-related neurological disorders during a three-year period from June 2000 to May 2003 were included. Data regarding clinical and laboratory features were obtained. Follow-up was done at least six months following treatment with parenteral vitamin B12. Chi-square test was used for statistical analysis. RESULTS: A total of 63 patients (52 males with a mean age of 46.2 years were studied. The mean duration of symptoms at presentation was 10.3 months. Myeloneuropathy (54% was the commonest neurological manifestation, followed by myeloneuropathy with cognitive dysfunction (34%, and peripheral neuropathy (9%. Neuropsychiatric manifestations and dementia were observed in 38% and 19% of patients respectively. All the patients had megaloblastic changes in the bone marrow smear. Eleven (17.5% patients had both hemoglobin and the mean corpuscular volume (MCV within the normal range. Follow-up after at least six months of therapy with parenteral B12 showed improvement in 54% patients. CONCLUSIONS: A high index of suspicion of B12def is required in patients presenting with myelopathy, cognitive decline, or neuropathy. A normal hemoglobin or MCV does not exclude B12def; therefore, other tests such as bone marrow smear and serum vitamin B12 assay are essential, as the condition is often reversible with treatment.
Eussen, S.J.; Groot, de C.P.G.M.; Joosten, L.W.; Bloo, R.; Clarke, R.; Ueland, P.M.; Schneede, J.; Blom, H.J.; Hoefnagels, W.H.; Staveren, van W.A.
Background: Vitamin B-12 deficiency is associated with cognitive impairment in older people. However, evidence from randomized trials of the effects of vitamin B-12 supplementation on cognitive function is limited and inconclusive. Objective: The objective was to investigate whether daily supplement
Eussen, S.; Groot, L.C. de; Joosten, L.W.; Bloo, R.J.; Clarke, R.; Ueland, P.M.; Schneede, J.; Blom, H.J.; Hoefnagels, W.H.L.; Staveren, W.A. van
BACKGROUND: Vitamin B-12 deficiency is associated with cognitive impairment in older people. However, evidence from randomized trials of the effects of vitamin B-12 supplementation on cognitive function is limited and inconclusive. OBJECTIVE: The objective was to investigate whether daily supplement
Mahmoud Mohammed Sirdah
Full Text Available OBJECTIVE: Nutritional deficiencies are very significant to the overall health of humans at all ages and for both genders, yet in infants, children and women of childbearing age these deficiencies can seriously affect growth and development. The present work is aimed to assess homocysteine and vitamin B12 status in females with iron deficiency anemia from the Gaza Strip.METHODS: Venous blood samples were randomly collected from 240 female university students (18-22 years old and parameters of the complete blood count, serum ferritin, homocysteine and vitamin B12 were measured. Statistical analysis included the t-test and analysis of variance (ANOVA using the IBM SPSS software (version 18. Statistical significance was set for p-values <0.05.RESULTS: The results revealed that 20.4% of the students have iron deficiency anemia. The mean serum vitamin B12 level in females with iron deficiency anemia (212.9 ± 62.8 pg/mL was significantly lower than in normal controls (286.9 ± 57.1 pg/mL and subjects with microcytic anemia and normal ferritin (256.7 ± 71.1 pg/mL. Significantly higher serum homocysteine levels were reported in the iron deficiency anemia group (27.0 ± 4.6 µmol/L compared to normal controls (15.5 ± 2.9 µmol/L and in subjects with microcytic anemia and normal ferritin (18.1 ± 2.7 µmol/L. Statistically significant negative correlations were reported for serum homocysteine with serum ferritin, vitamin B12, hemoglobin, and hematocrit levels.CONCLUSION: Important associations were found between serum homocysteine and markers of iron deficiency. Monitoring homocysteine levels might be essential to understand the development of different clinical conditions including anemia. It seems necessary to conduct prospective trials to determine whether treating anemia ameliorates homocysteine levels.
Results: The mean age of patients was 40.1 ± 17.4 years. In the pretreatment group, the mean level of vitamin B12 was 151.2 ± 34.6 pg/mL, the MPV was 7.8 ± 1.4 fL. In the posttreatment group, the mean vitamin B12 level was 638 ± 608 pg/mL, the MPV was 8.3 ± 1.3 fL. The levels of vitamin B12 (P < 0.001 and MPV (P < 0.001 were significantly higher in the posttreatment group than those in the pretreatment group. Conclusions: After one month of cobalamin treatment in patients with vitamin B12 deficiency, the levels of B12 and MPV were higher than the pretreatment levels. These results showed that vitamin B12 treatment may increases the release of large and active thrombocytes into the peripheral blood; therefore, caution may be needed in patients predisposed to thrombotic diseases. [Cukurova Med J 2014; 39(2.000: 329-335
Seung Min Song; Keun Wook Bae; Hoi-Soo Yoon; Ho Joon Im; Jong-Jin Seo
Anemia caused by vitamin B12 deficiency resulting from inadequate dietary intake is rare in children in the modern era because of improvements in nutritional status. However, such anemia can be caused by decreased ingestion or impaired absorption and/ or utilization of vitamin B12. We report the case of an 18-year-old man with short stature, prepubertal sexual maturation, exertional dyspnea, and severe anemia with a hemoglobin level of 3.3 g/dL. He had a history of small bowel resecti...
van Amsterdam JGC; Opperhuizen A; Jansen EHJM; TOX
Het Ministerie van VWS overweegt om bepaalde voedselbestanddelen te verrijken met foliumzuur. Foliumzuurverrijking houdt echter een gezondheidsrisico in, omdat het vitamine B12 deficientie maskeert, waardoor het de incidentie van megaloblastische anemie en perifere neuropathie kan verhogen. Dit ra
Mishra, Vikas A.; Harbada, Rishit; Sharma, Akhilesh
The array of diagnostic workup for pyrexia of unknown origin (PUO) generally revolves in searching for infections, inflammatory/autoimmune, and endocrine etiologies. A differential diagnosis of fever, hemolytic anemia, and thrombocytopenia can have etiologies varying from infections like malaria, dengue, cytomegalovirus, Ebstein barr virus, Parvovirus, infective endocarditis, to autoimmune disorder (systemic lupus erythromatosis), vasculitis, hemolytic uremic syndrome, thrombotic thrombocytopenic purpura (TTP), autoimmune hemolytic anemia/Evan's syndrome, paroxysmal nocturnal hemoglobinuri (PNH), or drugs. Nutritional deficiencies (especially vitamin B12 deficiency) as a cause of fever, hemolytic anemia, and thrombocytopenia are very rare and therefore rarely thought of. Severe vitamin B12 deficiency may cause fever and if accompanied by concurrent hyper-homocysteinemia and hypophosphatemia can sometimes lead to severe hemolysis mimicking the above-mentioned conditions. We present a case that highlights vitamin B12 and vitamin D deficiency as an easily treatable cause of PUO, hemolytic anemia, and thrombocytopenia, which should be actively looked for and treated before proceeding with more complicated and expensive investigation or starting empiric treatments. PMID:25811010
Full Text Available Abstract Background DNA methylation is an epigenetic phenomenon that can modulate gene function by up or downregulation of gene expression. Vitamin B12 and folate pathways are involved in the production of S-Adenosylmethionine, the universal methyl donor. Findings Brain vitamin B12 concentration and global DNA methylation was determined in transcobalamin receptor (TCblR/CD320 knock out (KO (n = 4 and control mice (n = 4 at 20–24 weeks of age. Median [IQR] brain vitamin B12 concentrations (pg/mg in TCblR/CD320 KO mice compared with control mice was 8.59 [0.52] vs 112.42 [33.12]; p CD320 KO compared with control mice (Median [IQR]: 0.31[0.16] % vs 0.55[0.15] %; p Conclusions In TCblR/CD320 KO mice, brain vitamin B12 drops precipitously by as much as 90% during a 20 week period. This decrease is associated with a 40% decrease in global DNA methylation in the brain. Future research will reveal whether the disruption in gene expression profiles due to changes in DNA hypomethylation contribute to central nervous system pathologies that are frequently seen in vitamin B12 deficiency.
Iftikhar, Raheel; Kamran, Sultan Mehmood; Qadir, Adnan; Iqbal, Zohaib; Usman, Hassan bin
Introduction Diabetes Mellitus is the most common endocrine disorder and metformin is the most commonly prescribed oral hypoglycemic agent. Metformin is well known to cause viamin B12 deficiency due to effect on calcium-dependent membrane action in the terminal ileum leading to malabsorption of vitamin B12. The purpose of this study is to determine prevalence and associations of Vitamin B12 deficiency in patients of type 2 diabetes mellitus treated with metformin. Methods This case control st...
Walter, Kara; Vaughn, Jennifer; Martin, Daniel
Background Idiopathic thrombotic thrombocytopenic purpura (TTP) is a rare hematological emergency characterized by the pentad of microangiopathic hemolytic anemia, thrombocytopenia, neurological symptoms, renal injury, and fever that is invariably fatal if left untreated. Prompt intervention with plasma exchange minimizes mortality and is the cornerstone of therapy. Rare reports have described “pseudo-TTP” driven by extreme hematologic abnormalities resulting from deficiency of vitamin B12. D...
Full Text Available Vitamin B12 deficiency is widely prevalent in women of childbearing age especially in developing countries. In the present study, through dietary restriction, we have established mouse models of severe and moderate vitamin B12 deficiencies to elucidate the impact on body composition, biochemical parameters and reproductive performance. Female weanling C57BL/6 mice were fed for four weeks, (a control AIN-76A diet, (b vitamin B12 restricted AIN-76A diet with pectin as dietary fiber (severe deficiency group, as pectin inhibits vitamin B12 absorption or (c vitamin B12 restricted AIN-76A diet with cellulose as dietary fiber (moderate deficiency group as cellulose does not interfere with vitamin B12 absorption. After confirming deficiency, the mice were mated with male colony mice and maintained on their respective diets throughout pregnancy, lactation and thereafter till 12 weeks. Severe vitamin B12 deficiency increased body fat % significantly, induced adiposity and altered lipid profile. Pregnant dams of both the deficient groups developed anemia. Severe vitamin B12 deficiency decreased the percentage of conception and litter size, pups were small-for-gestational-age and had significantly lower body weight at birth as well as weaning. Most of the offspring born to severely deficient dams died within 24 hours of birth. Stress markers and adipocytokines were elevated in severe deficiency with concomitant decrease in antioxidant defense. The results show that severe but not moderate vitamin B12 restriction had profound impact on the physiology of C57BL/6 mice. Oxidative and corticosteroid stress, inflammation and poor antioxidant defense seem to be the probable underlying mechanisms mediating the deleterious effects.
Peng, Lu; Dreumont, Natacha; Coelho, David; Guéant, Jean-Louis; Arnold, Carole
Vitamin B12 and folate are essential micronutrients that provide methyl groups for cellular methylations through the so-called one-carbon metabolism. Deficits in the absorption and transport or defects of the enzymes can lead to human pathogenesis comprising hematologic, neural, gastrointestinal, hepatic, renal, cardiovascular and developmental manifestations. One-carbon metabolism is a complex, multistep and multi-organ metabolism, and the understanding of the mechanisms at work have benefited from human inborn errors and population studies, as well as from nutritional animal models. Since 15 years, a wide variety of genetically engineered mice has been developed and has proved to be useful to decipher the underlying mechanisms. These genetically engineered mice target all the genes that are important for the intestinal absorption, cellular transport and metabolism of vitamin B12 and folate, which are detailed in this article. In conclusion, these mouse models represent valuable experimental paradigms for human pathogenesis. Since no animal model recapitulates the full spectrum of a human disease, researchers have to choose the one that is the most relevant for their specific needs, and this review may help in this respect. PMID:27178438
Ben Ghezala I
Full Text Available Inès Ben Ghezala, Johan Frederik Berg Arendt, Rune Erichsen, Jihen Zalfani, Henrik Gammelager, Trine Frøslev, Morten OlsenDepartment of Clinical Epidemiology, Aarhus University Hospital, Aarhus, DenmarkPurpose: The aim of this validation study was to assess the positive predictive value (PPV of the International Classification of Diseases, 10th revision (ICD-10 diagnosis of vitamin B12 (cobalamin [Cbl] deficiency anemia in the Danish National Patient Register (DNPR.Patients and methods: We identified all patients above 18 years of age recorded in the DNPR with a diagnosis of Cbl deficiency anemia (ICD-10 code: D51 admitted to two Danish university hospitals and one Danish regional hospital from 2000 through 2009. We assessed the PPV using biochemical parameters on Cbl deficiency with or without anemia as reference standards. These data were obtained from the Laboratory Information Systems Database. Data on prescriptions with Cbl supplementation drugs were obtained from the Aarhus University Prescription Database.Results: We identified 1089 patients coded with a Cbl deficiency anemia diagnosis in the DNPR. The PPV was 31.5% (95% confidence interval [CI]: 28.8%–34.3% and 36.8% (95% CI: 34.0%–39.7% depending on definitions of Cbl deficiency with anemia. When using Cbl deficiency without anemia as a reference standard, the PPV was 51.3% (95% CI: 48.4%–54.3%. The PPV for Cbl supplemented patients was 22.2% (95% CI: 18.0%–26.9% and for non-Cbl supplemented patients 63.9% (95% CI: 60.5%–67.3%.Conclusion: The PPVs of the ICD-10 diagnosis coding for Cbl deficiency anemia were generally low in the DNPR. Therefore, this register should be used with caution to study patients with Cbl deficiency anemia.Keywords: vitamin B12 deficiency anemia, Danish National Patient Register, Laboratory Information Systems Database, International Classification of Diseases, positive predictive value, validation study
Malouf, RM; Areosa Sastre, A
Background An association between neuropsychiatric disorders and vitamin B12 deficiency has been recognized since 1849 when pernicious anaemia was first described. It has been suggested that deficiency of vitamin B12 might contribute to age-associated cognitive impairment. Low serum vitamin B12 concentrations are found in more than 10% of older people. A high prevalence of low serum vitamin B12 levels, and other indicators of vitamin B12 deficiency have been reported among people with Alzh...
Full Text Available C o - existence of vitamin B 12 deficiencies along with iron has been observed among young females aged between 15 to 25 years .but limited evidence is available from india.so comparative study was done in young females with iron deficiency anaema in the improvement of haemoglobin % treated with iro n supplementation alone and iron along with B12 supplementation in Kadapa , A ndhra Pradesh. A total of 50 young females with moderate anaemia 1 (Hb % in between 8 - 10gm % were taken. T hey were divided into two groups .group - 1 consists of 25 patients treated with oral iron, group - 2 consists of 25 patients treated with oral iron and oral B12. R esults - significantly found that Hb% improvement was more in females treated with iron and B 12 compared with group treated with iron alone. Conclusion : This study shows that in addition to iron supplementation B12 supplementation was benefi cial in the improvement of Hb%
Krajcovicová-Kudlácková, M; Blazícek, P; Sebeková, K; Valachovicová, M
Prevalence of mild hyperhomocysteinemia in vegetarians and vegans is a consequence of vitamin B12 deficiency. Clinical study of homocysteine reduction by vitamin B12 consisted of subjective healthy adults on alternative nutrition (n = 9) with vitamin B12 deficiency and with mild hyperhomocysteinemia. Vitamin B12 treatment was implemented by 5 intramuscular cyanocobalamin injections of a total content of 2200 micrograms during two weeks. Homocysteine level was significantly reduced (from 22 mumol/l to 11.7 mumol/l; individual reduction 29-55%). Vitamin B12 concentration in blood was significantly increased (from 152 pmol/l to 277 pmol/l; individual % of increase 63-150). The results show a high effect of vitamin B12 treatment in homocysteine value reduction of subjects on alternative nutrition. PMID:12501494
Eoin P Quinlivan
Full Text Available Vitamin B12, a co-factor in methyl-group transfer, is important in maintaining DNA (deoxycytidine methylation. Using two independent assays we examined the effect of vitamin B12-deficiency (plasma vitamin B12<148 pmol/L on DNA methylation in women of childbearing age. Coagulated blood clot DNA from vitamin B12-deficient women had significantly (p<0.001 lower percentage deoxycytidine methylation (3.23±0.66%; n = 248 and greater [3 H]methyl-acceptance (42,859±9,699 cpm; n = 17 than DNA from B12-replete women (4.44±0.18%; n = 128 and 26,049±2,814 cpm; n = 11 [correlation between assays: r = -0.8538; p<0.001; n = 28]. In contrast, uncoagulated EDTA-blood cell pellet DNA from vitamin B12-deficient and B12-replete women exhibited similar percentage methylation (4.45±0.15%; n = 77 vs. 4.47±0.15%; n = 47 and [3 H]methyl-acceptance (27,378±4,094 cpm; n = 17 vs. 26,610±2,292 cpm; n = 11. Therefore, in simultaneously collected paired blood samples, vitamin B12-deficiency was associated with decreased DNA methylation only in coagulated samples. These findings highlight the importance of sample collection methods in epigenetic studies, and the potential impact biological processes can have on DNA methylation during collection.
Apte; Sinha; Rajput,, S.; Roshan; Madhu,
ABSTRACT: BACKGROUND: Vitamin B12 (Cobalamin) plays an important role in DNA synthesis and neurologic function. Deficiency can lead to a wide spectrum of hematologic and neuropsychiatric disorders that can o ften be reversed by early diagnosis and prompt treatment. MATERIAL AND METHODS: Cross sectional descriptive study carried out in Medicine department, SMIMER, Surat during the period from June 2009 to December 2010. 30 patients whose Serum Vitamin B12 level
The application concerns the manufacture of radioactive forms of vitamin B-12 in which the cobalt atom present in the vitamin B-12 molecule is replaced with a radioactive isotope of cobalt, usually cobalt-57 or cobalt-58. Such radioactive forms of B-12 are used extensively in the diagnosis of B-12 deficiency states
Nyholm, E.; Turpin, P; Swain, D; Cunningham, B.; Daly, S; P. Nightingale; Fegan, C
Oral vitamin B12 can provide an effective alternative to intramuscular injections, so giving patients a choice and reducing costs in primary care. This study investigated the effectiveness, safety, and acceptability of oral vitamin B12 as replacement therapy in patients with vitamin B12 deficiency in a city general practice population. Forty patients previously maintained on vitamin B12 injections were given 1000 µg of oral cyanocobalamin daily for up to 18 months. All the patients maintained...
Uwe Gröber; Klaus Kisters; Joachim Schmidt
Vitamin B12 is a cofactor of methionine synthase in the synthesis of methionine, the precursor of the universal methyl donor S-Adenosylmethionine (SAMe), which is involved in different epigenomic regulatory mechanisms and especially in brain development. A Vitamin B12 deficiency expresses itself by a wide variety of neurological manifestations such as paraesthesias, skin numbness, coordination disorders and reduced nerve conduction velocity. In elderly people, a latent Vitamin B12 deficiency ...
Focal spinal cord lesions have been present in all previously reported cases of MRI appearances in myelopathy complicating vitamin B12 deficiency. We describe two further cases showing mild atrophy only and review the salient features of the previous 11 publications. MRI findings reflect quite closely the known pathological changes in this condition. (orig.)
Zhuo, Jia-Min; Praticò, Domenico
Epidemiological and clinical studies indicate that elevated circulating level of homocysteine (Hcy) is a risk factor for developing Alzheimer's disease (AD). Dietary deficiency of folate, vitamin B6 and B12 results in a significant increase of Hcy levels, a condition also known as hyperhomocysteinemia (HHcy).
Seung Min Song
Full Text Available Anemia caused by vitamin B12 deficiency resulting from inadequate dietary intake is rare in children in the modern era because of improvements in nutritional status. However, such anemia can be caused by decreased ingestion or impaired absorption and/ or utilization of vitamin B12. We report the case of an 18-year-old man with short stature, prepubertal sexual maturation, exertional dyspnea, and severe anemia with a hemoglobin level of 3.3 g/dL. He had a history of small bowel resection from 50 cm below the Treitz ligament to 5 cm above the ileocecal valve necessitated by midgut volvulus in the neonatal period. Laboratory tests showed deficiencies of both vitamin B12 and iron. A bone marrow examination revealed dyserythropoiesis and low levels of hemosiderin particles, and a cytogenetic study disclosed a normal karyotype. After treatment with parenteral vitamin B12 and elemental iron, both anemia and growth showed gradual improvement. This is a rare case that presented with short stature and delayed puberty caused by nutritional deficiency anemia in Korea.
Fernàndez-Roig, Sílvia; Lai, Shao-Chiang; Murphy, Michelle M; Fernandez-Ballart, Joan; Quadros, Edward V.
Background DNA methylation is an epigenetic phenomenon that can modulate gene function by up or downregulation of gene expression. Vitamin B12 and folate pathways are involved in the production of S-Adenosylmethionine, the universal methyl donor. Findings Brain vitamin B12 concentration and global DNA methylation was determined in transcobalamin receptor (TCblR/CD320) knock out (KO) (n = 4) and control mice (n = 4) at 20–24 weeks of age. Median [IQR] brain vitamin B12 concentrations (pg/mg) i...
陈珊瑚; 张文辉; 周碧碧; 陈晓东
目的 探讨血清中活性维生素B12检测在维生素B12缺乏中的应用价值.方法 采用酶免疫发光分析竞争法检测血清中维生素B12和叶酸的含量,及ELISA法检测血清活性维生素B12,通过ROC曲线分析活性维生素B12在诊断维生素B12缺乏中的特异度和敏感度;并且通过回归分析活性维生素B12水平与性别、年龄、总维生素B12及叶酸的相关性;统计分析各疾病组中活性维生素B12含量的累积百分比.结果 血清活性维生素B12判断维生素B12缺乏的ROC曲线下面积为0.983,敏感度为60.0％,特异性为99.2％;活性维生素B12与总维生素B12和叶酸存在良好的正相关,P＜0.001,与年龄、性别不相关;各病例组中血液病组的活性维生素B12含量累计百分比最高,其次为神经系统疾病组.结论 血清活性维生素B12是用于临床维生素B12缺乏诊断较敏感、特异的指标,在血液病、神经系统疾病患者中,其临床应用价值更突出.
Full Text Available Abstract Background In infants, vitamin B12 deficiency may be due to an inborn error of absorption and metabolism, or nutritional problems. Case presentation An exclusively breastfed 5-month-old Italian male infant, who was born after a normal full-term pregnancy to a vegan mother who was apparently daily treated with a multivitamin oral preparation during the second and third trimester, was hospitalised because of poor weight gain, feeding difficulties, severe pallor, muscle hypotonia and somnolence. Upon admission, his weight, length and head circumference were below the third percentile, he had an enlarged liver and spleen, and showed a significant delay in developmental milestones and communicative reactions. He had a hemoglobin level of 4.7 g/dL with an MCV of 84.2 fL, a white blood cell count of 4,680/mm3, and a platelet count of 45,000/mm3. His serum vitamin B12 level was 57 pg/mL (normal value 180–500 pg/mL and serum folate level 12.8 ng/mL (normal value >3 ng/mL. The results of metabolic examinations excluded a cobalamin C disorder, whereas nutritional screening showed a serum iron concentration of 9 μg/dL and serum ferritin of 4 ng/mL. Magnetic resonance imaging of the brain showed mild dilatation of the lateral ventricles with diffuse delayed myelination. The child was diagnosed as having vitamin B12 and iron deficiency due to nutritional inadequacy and was immediately treated with packed red blood cells, intramuscular vitamin B12 injections, and iron supplementation. A few days after the start of therapy, his hemoglobin levels and other hematological parameters rapidly improved, and a clinical improvement was observed within few weeks. There was an increase in his achievement of developmental milestones, but his development was still retarded seven months after the start of therapy. Conclusion This case underlines the importance of adequately controlling maternal vitamin B12 intake during pregnancy by means of
Guez Sophie; Chiarelli Gabriella; Menni Francesca; Salera Simona; Principi Nicola; Esposito Susanna
Abstract Background In infants, vitamin B12 deficiency may be due to an inborn error of absorption and metabolism, or nutritional problems. Case presentation An exclusively breastfed 5-month-old Italian male infant, who was born after a normal full-term pregnancy to a vegan mother who was apparently daily treated with a multivitamin oral preparation during the second and third trimester, was hospitalised because of poor weight gain, feeding difficulties, severe pallor, muscle hypotonia and so...
Vitamin B-12 treatment of asymptomatic, deficient, elderly Chileans improves conductivity in myelinated periphreal nerves, but high serum folate impairs vitamin B-12 status response assessed by the combined indicator of...
Since 2005 the National Feeding Program for the Elderly (PACAM) in Chile has provided a B12 fortified milk drink (1.7 µg B12/d) which is insufficient to ensure B12 adequacy in many individuals. The objective was to evaluate effects of adding 1 mg B12/d to PACAM vs 1 mg B12/d as a pill with PACAM on ...
Full Text Available ABSTRACT: BACKGROUND: Vitamin B12 (Cobalamin plays an important role in DNA synthesis and neurologic function. Deficiency can lead to a wide spectrum of hematologic and neuropsychiatric disorders that can o ften be reversed by early diagnosis and prompt treatment. MATERIAL AND METHODS: Cross sectional descriptive study carried out in Medicine department, SMIMER, Surat during the period from June 2009 to December 2010. 30 patients whose Serum Vitamin B12 level <250 pg/ml w e re included. RESULT: The most common complaint was fatigue present in 29(96.7% followed by anorexia, present in 19 (63.3% patients. Anemia was observed in 25(83.3% patients. Out of this 25 patients with anemia 13(52% patients had leucopeni a, and 15(60% patients had thrombocytopenia (platelet count<150000/cumm, while 10 (40% patient had normal platelet count. 13(52% out of 25 anemic patients had MCV of 80 - 100 fl, while 11(44% had MCV more than 100 fl. 15 patients had neurological featur es, myeloneuropathy (4 patients and neurocognitive disorder with neuropathy(4 patients were the commonest feature. CONCLUSION: In patients with Vitamin B12 deficiency anorexia and fatigue are most common symptoms even in absence of anaemia. Anaemia can b e associated with normal or high MCV. Pancytopenia is a common feature. The most common neurological presentations were neuropathy and neuropsychiatric involvement
Evolution and treatment of vitamin B12 deficiency as a risk factor for (cognitive and functional) neurodegenerative diseases in institutionalized elderly = Evolución y tratamiento de la deficiencia de vitamina B12 como factor de riesgo de enfermedades neurodegenerativas (cognitivas y funcionales) en las personas mayores institucionalizadas.
Prevalence of vitamin B12 deficiency is very common in elderly people and can reach values as high as 40.5% of the population. It can be the result of the interaction among several factors. Vitamin B12 deficiencies have been associated with neurological, cognitive deterioration, haematological abnormalities and cardiovascular diseases that have an important influence on the health of the elderly and their quality of life. It is necessary to approach the problems arisen from the lack of data r...
Cobalamin deficiency is common in older people and has been recognised as a possible cause for several clinical manifestations such as anaemia and cognitive impairment. Markers for cobalamin deficiency include increased concentrations of plasma total homocysteine (tHcy) and methylmalonic acid (MMA),
Greibe, E; Miller, J W; Foutouhi, S H;
AIMS/HYPOTHESIS: Patients treated with metformin exhibit low levels of plasma vitamin B(12) (B(12)), and are considered at risk for developing B(12) deficiency. In this study, we investigated the effect of metformin treatment on B(12) uptake and distribution in rats. METHODS: Sprague Dawley rats (n...... = 18) were divided into two groups and given daily subcutaneous injections with metformin or saline (control) for three weeks. Following this, the animals received an oral dose of radio-labeled B(12) ((57)[Co]-B(12)), and urine and feces were collected for 24 h. Plasma, bowel content, liver, and...... kidneys were collected and analyzed for B(12), unsaturated B(12)-binding capacity, and (57)[Co]-B(12). RESULTS: Three weeks of metformin treatment reduced plasma B(12) by 22% or 289 [47-383] pmol/L (median and [range]) (p = 0.001), while no effect was observed on unsaturated B(12)-binding capacity...
Pepper, M Reese; Black, Maureen M
Vitamin B12 (cobalamin) is necessary for development of the fetus and child. Pregnant women who are vegetarian or vegan, have Crohn's or celiac disease, or have undergone gastric bypass surgery are at increased risk of B12 deficiency. Low serum levels of B12 have been linked to negative impacts in cognitive, motor, and growth outcomes. Low cobalamin levels also may be related to depression in adults. Some studies indicate that B12 supplementation may improve outcomes in children, although more research is needed in this area. Overall, the mechanisms of B12 action in development remain unclear. Further studies in this area to elucidate the pathways of cobalamin influence on development, as well as to prevent B12 deficiency in pregnant women and children are indicated. PMID:21664980
Cobalamin deficiency is common in older people and has been recognised as a possible cause for several clinical manifestations such as anaemia and cognitive impairment. Markers for cobalamin deficiency include increased concentrations of plasma total homocysteine (tHcy) and methylmalonic acid (MMA), and decreased concentrations of holotranscobalamin (holoTC). Cross sectional analysis in this thesis confirmed that impaired cognitive performance was associated with relatively unfavourable conce...
Vitamin B12 deficiency is common in people of all ages who consume a low intake of animal-source foods, including populations in developing countries. It is also prevalent among the elderly, even in wealthier countries, due to their malabsorption of B12 from food. Several methods have been applied t...
Lai, Shao-Chiang; Nakayama, Yasumi; Sequeira, Jeffrey M.; Wlodarczyk, Bogdan J.; Cabrera, Robert M.; Finnell, Richard H.; Bottiglieri, Teodoro; Quadros, Edward V.
The membrane receptor (TCblR/CD320) for transcobalamin (TC)-bound cobalamin (Cbl) facilitates the cellular uptake of Cbl. A genetically modified mouse model involving ablation of the CD320 gene was generated to study the effects on cobalamin homeostasis. The nonlethal nature of this knockout and the lack of systemic cobalamin deficiency point to other mechanisms for cellular Cbl uptake in the mouse. However, severe cobalamin depletion in the central nervous system (CNS) after birth (P
Lai, Shao-Chiang; Nakayama, Yasumi; Sequeira, Jeffrey M; Wlodarczyk, Bogdan J; Cabrera, Robert M; Finnell, Richard H; Bottiglieri, Teodoro; Quadros, Edward V
The membrane receptor (TCblR/CD320) for transcobalamin (TC)-bound cobalamin (Cbl) facilitates the cellular uptake of Cbl. A genetically modified mouse model involving ablation of the CD320 gene was generated to study the effects on cobalamin homeostasis. The nonlethal nature of this knockout and the lack of systemic cobalamin deficiency point to other mechanisms for cellular Cbl uptake in the mouse. However, severe cobalamin depletion in the central nervous system (CNS) after birth (Pmouse model; however, it does provide a model with which to evaluate metabolic pathways and genes affected. PMID:23430977
Stoffregen, Clemens C; Odin, Elisabeth A; Carlsson, Göran U; Kurlberg, Göran K; Björkqvist, Hillevi G; Tångefjord, Maria T; Gustavsson, Bengt G
The objectives of this single-center, open-label, phase II study were to evaluate (a) the feasibility and safety of neoadjuvant administration of pemetrexed with oral folic acid and vitamin B12 (FA/B12) in newly diagnosed patients with resectable rectal cancer and (b) intracellular and systemic vitamin metabolism. Patients were treated with three cycles of pemetrexed (500 mg/m, every 3 weeks) and FA/B12 before surgery. The reduced folates tetrahydrofolate, 5-methyltetrahydrofolate, and 5,10-methylenetetrahydrofolate were evaluated from biopsies in tumor tissue and in adjacent mucosa. Serum levels of homocysteine, cystathionine, and methylmalonic acid were also measured. All 37 patients received three cycles of pemetrexed; 89.2% completed their planned dosage within a 9-week feasibility time frame. Neither dose reductions nor study drug-related serious adverse events were reported. Reduced folate levels were significantly higher in tumor tissue compared with adjacent mucosa at baseline. After FA/B12 administration, tissue levels of reduced folates increased significantly and remained high during treatment in both tumor and mucosa until surgery. Serum levels of cystathionine increased significantly compared with baseline after FA/B12 administration, but then decreased, fluctuating cyclically during pemetrexed therapy. Homocysteine and methylmalonic acid levels decreased significantly after FA/B12 administration, and remained below baseline levels during the study. These results indicate that administration of three neoadjuvant cycles of single-agent pemetrexed, every 3 weeks, with FA/B12 in patients with resectable rectal cancer is feasible and tolerable. Tissue and serum vitamin metabolism results demonstrate the influence of pemetrexed and FA/B12 on vitamin metabolism and warrant further study. PMID:26825869
Incidência da deficiência de vitamina B12 em pacientes submetidos à cirurgia bariátrica pela técnica Fobi-Capella (Y-de-Roux Incidence of vitamin B12 deficiency in patients submitted to Fobi-Capella Roux-en-Y bariatric surgery
Iara Ribeiro Carvalho
Full Text Available RACIONAL: Os pacientes submetidos à cirurgia bariátrica podem desenvolver, ao longo do tempo, algumas complicações e a anemia é quadro importante decorrente da ressecção gástrica, levando à deficiência de ferro, ácido fólico ou vitamina B. OBJETIVO: Verificar a incidência da deficiência de vitamina B12 e comparar dados antropométricos e bioquímicos do pré e pós-operatório (seis meses, em pacientes submetidos à cirurgia bariátrica Fobi-Capella (Y de Roux. MÉTODOS: Análise retrospectiva e descritiva de 91 prontuários de pacientes submetidos à operação. Foram coletadas informações pessoais, data do procedimento e valores do pré e pós-operatório (seis meses, redução de peso, co-morbidades, colesterol, triglicérides, glicemia, vitamina B12, hemoglobina e hematócrito. Para análise estatística foi utilizado nível de significância de 5% (pBACKGROUND: Patients undergoing bariatric surgery may develop over time, some complications and anemia is an important one due to gastric resection, leading to iron, folic acid or vitamin B12 deficiency. AIM: To determine the incidence of deficiency of vitamin B12 and other anthropometric and biochemical data comparing the preoperative and postoperative (six months period in patients who underwent bariatric surgery with Fobi-Capella (Roux-en-Y technique. METHODS: Retrospective and descriptive analysis of 91 charts of patients who underwent surgery. It was collected personal information, date of surgery and pre-and postoperative (six months values, weight loss, comorbidities, serum analysis of total cholesterol, triglycerides, glucose, vitamin B12, hemoglobin and hematocrit. For statistical analysis, it was considered significance level of 5% (p<0.05. RESULTS: It was found that there was a reduction in weight of 25,0% compared with the preoperative value and the average BMI was from 41,2±4,9 kg/m² to 30,7±3,9 kg/m². The most common co-morbidities were dyspnea (93,4%, spine
Gröber, Uwe; Kisters, Klaus; Schmidt, Joachim
Vitamin B12 is a cofactor of methionine synthase in the synthesis of methionine, the precursor of the universal methyl donor S-Adenosylmethionine (SAMe), which is involved in different epigenomic regulatory mechanisms and especially in brain development. A Vitamin B12 deficiency expresses itself by a wide variety of neurological manifestations such as paraesthesias, skin numbness, coordination disorders and reduced nerve conduction velocity. In elderly people, a latent Vitamin B12 deficiency can be associated with a progressive brain atrophy. Moderately elevated concentrations of homocysteine (>10 µmol/L) have been associated with an increased risk of dementia, notably Alzheimer's disease, in many cross-sectional and prospective studies. Raised plasma concentrations of homocysteine is also associated with both regional and whole brain atrophy, not only in Alzheimer's disease but also in healthy elderly people. Clinician awareness should be raised to accurately diagnose and treat early Vitamin B12 deficiency to prevent irreversible structural brain damage. PMID:24352086
Full Text Available Vitamin B12 is essential for DNA synthesis and for cellular energy production. This review aims to outline the metabolism of vitamin B12, and to evaluate the causes and consequences of sub-clinical vitamin B12 deficiency. Vitamin B12 deficiency is common, mainly due to limited dietary intake of animal foods or malabsorption of the vitamin. Vegetarians are at risk of vitamin B12 deficiency as are other groups with low intakes of animal foods or those with restrictive dietary patterns. Malabsorption of vitamin B12 is most commonly seen in the elderly, secondary to gastric achlorhydria. The symptoms of sub-clinical deficiency are subtle and often not recognized. The long-term consequences of sub-clinical deficiency are not fully known but may include adverse effects on pregnancy outcomes, vascular, cognitive, bone and eye health.
MENU Return to Web version Vitamin B-12 Vitamin B-12 What is vitamin B-12? Vitamin B-12 is an important nutrient that is found naturally ... shellfish, meat, eggs, dairy products, and fortified foods. Vitamin B-12 helps make red blood cells and ...
The vitamin B12 level is a blood test that measures how much vitamin B12 is in your blood. ... form of megaloblastic anemia caused by poor vitamin B12 absorption. This can occur when the stomach makes ...
... with other B vitamins, such as niacin, riboflavin, vitamin B6, and magnesium. A prescription form of vitamin B12 ... Nutrition Board. Dietary Reference Intakes: Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin, and Choline. ...
Dobson, Ruth; Alvares, Debie
A 22-year-old woman presented with progressive sensory ataxia and optic neuropathy. Previous investigation by her general practitioner had found a low serum vitamin B12, which had been corrected with oral supplementation. Neurological investigations showed raised plasma homocysteine and methylmalonic acid towards the upper limit of normal with a low serum vitamin B12 MRI showed an extensive cord lesion in keeping with subacute combined degeneration of the spinal cord. We treated her with high dose parenteral vitamin B12 and she has made a partial recovery. We discuss the management of patients who present with neurological manifestations of vitamin B12 deficiency; highlighting the fact that parenteral replacement is needed in such cases, even if the serum vitamin B12 level appears to be normal. We also discuss ancillary investigations that should be performed in patients with suspected vitamin B12 deficiency. PMID:27009308
In a recent study of older participants (age >/= 60 y) in the 1999-2002 National Health and Nutrition Examination Survey (NHANES), we showed that a combination of high serum folate and low vitamin B-12 status was associated with higher prevalence of cognitive impairment and anemia than other combina...
Miller, A; Furlong, D; Burrows, B A; Slingerland, D W
In many patients with low serum levels of vitamin B12, the absorption of the free vitamin has been normal. The present study, using a total body counter 57CoB12 absorption method that clearly separated those with intrinsic factor deficiency from controls, found that of 94 patients with low B12 levels and intact stomachs in whom the absorption of free and bound B12 was determined, 44 (47%) had normal absorption of both. However, 20 of the 94 (21%) with normal absorption of free B12 had low absorption of bound B12. The remainder (32%) had low absorption of both free and bound B12. All patients with high serum gastrin levels had low bound B12 absorption, but so did 21% of those patients with normal serum gastrin levels. PMID:1609768
Lubis, Zulhaida; . Hardinsyah; Syarief, Hidayat; Jalal, Fasli; Muhilal
This research aimed to analyze prevalence of vitamin B12 deficiency and anemia, and effects of vitamin B12 suplement on vitamin B12 serum and hemoglobin of preschool children. A randomized controlled trial of 32 preschool children (4-6 year) for 6 months was appliad. Subjects divided in to 2 groups, treatment group (received 10 μg vitamin B12 syrup daily) and control group (placebo). Consentration of vitamin B12 serum and hemoglobin of children was measured before and after their intervent...
Vitamin B-12 is a cofactor for 2 enzymes. In the cytoplasm, methionine synthase requires vitamin B-12 in the form of methylcobalamin and catalyzes the conversion of homocysteine to methionine by transfer of a methyl group from methyltetrahydrofolate.This enzyme links the methylation pathway through ...
Ayşe Tosun; Yusuf Ziya Aral; Emre Çeçen; Ayvaz Aydoğdu; Bilin Çetinkaya Çakmak
Megaloblastic anemia is rare in infants and is generally due to vitamin B12 (cobalamin) deficiency in the mother. Neurologic symptoms of vitamin B12 deficiency include irritability, failure to thrive, hypotonia, and developmental regression/delay. Herein we present 2 infants with vitamin B12 that developed movement disorder 5 d after initiation of vitamin B12 treatment. Symptoms included tremor and myoclonus, involving in particular the face, tongue, and hands. Clinical findings in infants as...
Full Text Available Vitamin B12 is a cofactor of methionine synthase in the synthesis of methionine, the precursor of the universal methyl donor S-Adenosylmethionine (SAMe, which is involved in different epigenomic regulatory mechanisms and especially in brain development. A Vitamin B12 deficiency expresses itself by a wide variety of neurological manifestations such as paraesthesias, skin numbness, coordination disorders and reduced nerve conduction velocity. In elderly people, a latent Vitamin B12 deficiency can be associated with a progressive brain atrophy. Moderately elevated concentrations of homocysteine (>10 µmol/L have been associated with an increased risk of dementia, notably Alzheimer’s disease, in many cross-sectional and prospective studies. Raised plasma concentrations of homocysteine is also associated with both regional and whole brain atrophy, not only in Alzheimer’s disease but also in healthy elderly people. Clinician awareness should be raised to accurately diagnose and treat early Vitamin B12 deficiency to prevent irreversible structural brain damage.
... sprue Chronic myelogenous leukemia (CML) Cirrhosis Delirium Dementia Dementia due to metabolic causes Hepatitis Hyperthyroidism Malabsorption Pernicious anemia Polycythemia vera Reticulocyte count Vitamin B12 Update Date 2/24/2014 Updated by: ...
... prevent or treat dementia. Energy and athletic performance Advertisements often promote vitamin B12 supplements as a way ... 24, 2011 Share This Page: E-mail Twitter Facebook Google+ Pinterest Contact Us | Accessibility | Site Policies | Disclaimer | ...
Estimation of vitamin B12 in blood is very important to determine in deficiency and diagnosis of anemic patients. Vitamin B12 in blood can be estimated by spectrochemical, enzymatic, radioisotopic and microbiological methods. In the present study vitamin B12 was determined in 48 normal subjects of Rawalpindi/Islamabad by radiometric microbiological assay (RMA) technique using a very rapid, sensitive and automated instrument Bactec 460. In this procedure 14C-glucose media and microorganisms Lactobacillus leichmannii were used. The sensitivity of the method for vitamin B12 is 1 pg/ml and the vitamin B12 found in normal subjects was in the range of 105-535 pg/ml with a median value of 246±6 pg/ml. (author) 26 refs.; 1 fig
Dawson, D. W.; Sawers, A H; Sharma, R. K.
Patients with subnormal serum vitamin B12 concentrations were tested for absorption of protein bound vitamin B12 and compared with controls. Absorption of the protein bound vitamin appeared to decrease with increasing age in healthy subjects. Differences between the result of this test and the result of the Schilling test in patients who had undergone gastric surgery were confirmed; such differences were also seen in some patients who had iron deficiency anaemia, an excessive alcohol intake, ...
Gian Maria Pacifici
Full Text Available Vitamin B12 (cobalamin is an essential coenzyme for nucleic acid synthesis. Animal protein is the major dietary source of vitamin B12. Deficiency of vitamin B12 leads to megaloblastic anemia, degeneration of the brain, spinal cord, peripheral nerves, and abnormalities of epithelial tissues. Two factors are necessary for the cure of megaloblastic anemia: one in food (extrinsic factor and one in gastric juice (intrinsic factor. The extrinsic factor is vitamin B12. Intrinsic factor (a glycoprotein secreted by gastric parietal cells ensures cobalamin absorption by receptors in the terminal ileum. Vitamin B12 is actively transported across the placenta. Neonates have high serum levels and significant liver stores of vitamin B12. The neonates born to mothers with deficiency of vitamin B12 have deficiency of this vitamin. Pregnant women in resource-poor areas have low vitamin B12 status which is associated with adverse pregnancy outcomes, including anemia, low birth weight, and intrauterine growth retardation. Supplementation of vitamin B12 had significantly higher plasma of vitamin B12 in mothers and neonates. A single intramuscularly injection of vitamin B12 of between 250 µg and 1mg and a dietary intake of 1 µg/kg per day vitamin B12 is sufficient to combat vitamin B12 deficiency. Mean DNA damage scores in infants with vitamin B12 deficiency and their mothers were significantly higher before than after supplementation with vitamin B12. There were correlations between the infants' and their mothers' DNA damage scores. The aim of this study is the review of the effects of vitamin B12 in neonates and young infants.
Elmadfa, Ibrahim; Singer, Ingrid
Evidence exists that well-planned vegetarian diets provide numerous health benefits and are appropriate for all stages of the life cycle. It is also known that animal foods provide micronutrients that are nonexistent or available only in limited amounts in plant foods. Restriction or exclusion of all animal foods may therefore result in low intake of certain micronutrients such as vitamin B-12, thereby affecting vitamin B-12 status and elevating plasma homocysteine concentrations. Overall, the studies we reviewed showed reduced mean vitamin B-12 status and elevated mean homocysteine concentrations in vegetarians, particularly among vegans. Low vitamin B-12 intake may lead to decreased bioavailability and functional deficiency of cobalamin. Although early noticeable symptoms of vitamin B-12 deficiency are nonspecific (unusual fatigue, digestion problems, frequent upper respiratory infections), the best-known clinical manifestations of cobalamin malabsorption are hematologic (pernicious anemia) and neurologic symptoms. Hyperhomocysteinemia is associated with an increased risk of atherosclerosis and cardiovascular disease. Given these health concerns, vegetarians, particularly vegans, must be advised to carefully plan their diets, to monitor their plasma vitamin B-12 on a regular basis to facilitate early detection of low cobalamin status, and to use vitamin B-12-fortified foods or take vitamin B-12 supplements if necessary. PMID:19357223
Gian Maria Pacifici
Vitamin B12 (cobalamin) is an essential coenzyme for nucleic acid synthesis. Animal protein is the major dietary source of vitamin B12. Deficiency of vitamin B12 leads to megaloblastic anemia, degeneration of the brain, spinal cord, peripheral nerves, and abnormalities of epithelial tissues. Two factors are necessary for the cure of megaloblastic anemia: one in food (extrinsic factor) and one in gastric juice (intrinsic factor). The extrinsic factor is vitamin B12. Intrinsic factor (a glycopr...
Winkels, R.M.; Brouwer, I.A.; Clarke, R.; Katan, M.B.; Verhoef, P.
Background: Mandatory fortification of flour with folic acid has reduced the number of neural tube defects in North America. Concerns that high intakes of folic acid might mask vitamin B-12 deficiency in older persons have delayed the introduction of fortification in many European countries. Coforti
Wickramasinghe, S. N.; Fida, S
AIMS--To study the correlations between total vitamin B12(B12), holo-haptocorrin, and holo-transcobalamin II (holo-TCII) concentrations in human sera; the association between reduced holo-TCII concentrations and macrocytosis attributable to B12 deficiency. METHODS--Serum samples from 38 healthy volunteers, 113 patients with normal total serum B12 concentrations and 93 patients with low total serum B12 were studied. Holo-TCII was removed from whole serum by adsorption with amorphous precipitat...
A feeding experiment conducted in a controlled environment and using a vitamin B12-deficient, but otherwise nutritionally complete, purified diet revealed that intestinal microorganisms in channel catfish synthesized approximately 1.4 ng of vitamin B12 per gram of bodyweight per day. Removal of cobalt from the diet or supplementation with an antibiotic (succinylsulfathiazole) significantly reduced the rate of intestinal synthesis and liver stores of vitamin B12. Radiolabeled vitamin B12 in the blood, liver, kidneys, and spleen of fish fed 60Co in the diet indicated that the intestinally synthesized vitamin was absorbed by the fish. The primary route of absorption was directly from the digestive tract into the blood because coprophagy was prevented in the rearing aquariums and the amount of vitamin B12 dissolved in the aquarium water was too low for gill absorption. Dietary supplementation of vitamin B12 was not necessary for normal growth and erythrocyte formation in channel catfish in a 24-week feeding period. A longer period, however, may have caused a vitamin deficiency since liver-stored vitamin B 12 decreased between the 2nd and 24th weeks
本文对维生素B12的吸收与代谢、缺乏原因及疾病、营养水平鉴定、人群维生素B12营养状况、食物强化的研究进展进行了综述,以期提高对维生素B12的认识和重视、为解决维生素B12缺乏人群的健康问题提供参考.%In order to improve the awareness and attention on the importance of vitamin Bl2and to provide reference for solving problems of vitamin B12 deficiency, this review concentrates on five aspects of studies on vitamin B12: absorption and metabolism of vitamin BI2; cause/outcome of deficiency; biomarkers and their application; vitamin B12 status; and supplementation and fortification.
Doğan, Melike; Demirci, Serpil
Vitamin B12 is a water-soluble vitamin essential for growth and development in humans. It is required for methylation reactions and DNA synthesis. Vitamin B12 deficiency has a causal relationship with a variety of disease and is also recognized as a risk factor for some others. Megaloblastic anemia and neurological disorders are the most prevalent disorders seen with vitamin B12 deficiency. In this review, vitamin B12's absorption, the main physiological functions and the role of it in pathog...
Hunger, Miriam; Mutti, Elena; Rieder, Alexander;
humans and animals, through the endogenous B12 transport systems. Binding of the organometallic B12 octadecanucleotide to the three important human proteins of B12 transport was studied, to examine its structural suitability for the task of eventual in vivo oligonucleotide delivery. Binding was efficient......Design, synthesis, and structural characterization of a B12-octadecanucleotide are presented herein, a new organometallic B12-DNA conjugate. In such covalent conjugates, the natural B12 moiety may be a versatile vector for controlled in vivo delivery of oligonucleotides to cellular targets in...... with transcobalamin (TC), but not so efficient with the homologous glycoproteins intrinsic factor and haptocorrin. Binding of the B12 octadecanucleotide to TC suggests the capacity of the B12 moiety to serve as a natural vector for specific transport of single stranded, organometallic oligonucleotide...
Woo, Kam S; Kwok, Timothy C Y; Celermajer, David S
Vegetarian diets have been associated with atherosclerosis protection, with healthier atherosclerosis risk profiles, as well as lower prevalence of, and mortality from, ischemic heart disease and stroke. However, there are few data concerning the possible cardiovascular effects of a vegan diet (with no meat, dairy or egg products). Vitamin B-12 deficiency is highly prevalent in vegetarians; this can be partially alleviated by taking dairy/egg products in lact-ovo-vegetarians. However, metabolic vitamin B-12 deficiency is highly prevalent in vegetarians in Australia, Germany, Italy and Austria, and in vegans (80%) in Hong Kong and India, where vegans rarely take vitamin B-12 fortified food or vitamin B-12 supplements. Similar deficiencies exist in northern Chinese rural communities consuming inadequate meat, egg or dairy products due to poverty or dietary habits. Vascular studies have demonstrated impaired arterial endothelial function and increased carotid intima-media thickness as atherosclerosis surrogates in such metabolic vitamin B-12 deficient populations, but not in lactovegetarians in China. Vitamin B-12 supplementation has a favourable impact on these vascular surrogates in Hong Kong vegans and in underprivileged communities in northern rural China. Regular monitoring of vitamin B-12 status is thus potentially beneficial for early detection and treatment of metabolic vitamin B-12 deficiency in vegans, and possibly for prevention of atherosclerosis-related diseases. PMID:25195560
Kam S. Woo
Full Text Available Vegetarian diets have been associated with atherosclerosis protection, with healthier atherosclerosis risk profiles, as well as lower prevalence of, and mortality from, ischemic heart disease and stroke. However, there are few data concerning the possible cardiovascular effects of a vegan diet (with no meat, dairy or egg products. Vitamin B-12 deficiency is highly prevalent in vegetarians; this can be partially alleviated by taking dairy/egg products in lact-ovo-vegetarians. However, metabolic vitamin B-12 deficiency is highly prevalent in vegetarians in Australia, Germany, Italy and Austria, and in vegans (80% in Hong Kong and India, where vegans rarely take vitamin B-12 fortified food or vitamin B-12 supplements. Similar deficiencies exist in northern Chinese rural communities consuming inadequate meat, egg or dairy products due to poverty or dietary habits. Vascular studies have demonstrated impaired arterial endothelial function and increased carotid intima-media thickness as atherosclerosis surrogates in such metabolic vitamin B-12 deficient populations, but not in lactovegetarians in China. Vitamin B-12 supplementation has a favourable impact on these vascular surrogates in Hong Kong vegans and in underprivileged communities in northern rural China. Regular monitoring of vitamin B-12 status is thus potentially beneficial for early detection and treatment of metabolic vitamin B-12 deficiency in vegans, and possibly for prevention of atherosclerosis-related diseases.
Melike Sezgin Evim; Rahime Tüten; Birol Baytan; Selin Yakarışık; Adalet Meral Güneş
Vitamin B12 is essential to all cells in the body. Both high levels and low levels of vitamin B12 are significant. High serum cobalamin (vitamin B12) levels are found particularly in hematological disorders, solid tumors, autoimmune diseases, renal diseases and infectious diseases; and this elevation is associated with prognosis in some of these diseases. High levels of serum vitamin B12 should be taken into consideration and more studies should be performed on this issue.
Melike Sezgin Evim
Full Text Available Vitamin B12 is essential to all cells in the body. Both high levels and low levels of vitamin B12 are significant. High serum cobalamin (vitamin B12 levels are found particularly in hematological disorders, solid tumors, autoimmune diseases, renal diseases and infectious diseases; and this elevation is associated with prognosis in some of these diseases. High levels of serum vitamin B12 should be taken into consideration and more studies should be performed on this issue.
Delva, M. Dianne; Anderson, J E
A retrospective chart audit was undertaken to determine the clinical reasons for vitamin B12 therapy in family practice. Abnormal laboratory tests and symptoms were the most common reasons for initiating therapy. The high proportion of cases with little supporting evidence of B12 deficiency suggests that other factors influence treatment decisions.
Janak Rathod , Taral Shah , Manisha Gupta, Rajendra Mehta
Objectives: This study was an attempt to evaluate the advantage of empirical use of Injection. Vitamin B 12 versus symptomatic management in clinically suspected Vitamin. B 12 deficient patients. Methodology: A total of 100 patients over 20 years of age (irrespective of gender) were included in the study. The patients were divided into two groups, one group ( n = 50) receiving vitamin B12 injections and the other group (n = 50) received symptomatic treatment. Results: In clinically suspected ...
Janak Rathod , Taral Shah , Manisha Gupta, Rajendra Mehta
Full Text Available Objectives: This study was an attempt to evaluate the advantage of empirical use of Injection. Vitamin B 12 versus symptomatic management in clinically suspected Vitamin. B 12 deficient patients. Methodology: A total of 100 patients over 20 years of age (irrespective of gender were included in the study. The patients were divided into two groups, one group ( n = 50 receiving vitamin B12 injections and the other group (n = 50 received symptomatic treatment. Results: In clinically suspected vitamin B12 deficient patients after giving empirical therapy of Inj. Vit B 12; generalized fatigue (96%, pareshtesia (93.48%, myalgia (93.75%, loss of appetite (88.89%, confusion (93.75% and tremor (93.55% were improved with ( p<0.001. Labored breathing and depression were also improved with Inj.Vit B 12 as compared to symptomatic management, but this difference was statistically insignificant(p = 0.052 and p = 0.201 respectively. Conclusion: We conclude and recommend from the study to treat clinically suspected Vit. B 12 deficient patients with empirical Vit. B 12 Injections without the need of costly serum Vit. B 12 estimation
Dietzfelbinger, Hermann; Hubmann, Max
Hemolytic anemias consist of corpuscular, immun-hemolytic and toxic hemolytic anemias. Within the group of corpuscular hemolytic anemias, except for the paroxysmal nocturnal hemoglobinuria (PNH), all symptoms are caused by underlying heredetiary disorders within the red blood cell membran (hereditary spherocytosis), deficiencies of red cell enzymes (G6PDH- and pyrovatkinase deficiency) or disorders in the hemoglobin molecule (thalassaemia and sickle cell disease). Immune-hemolytic anemias are acquired hemolytic anemias and hemolysis is caused by auto- or allo-antibodies which are directed against red blood cell antigens. They are classified as warm, cold, mixed type or drug-induced hemolytic anemia. Therapy consists of glucocorticoids and other immunsuppressive drugs. Pernicious anemia is the most important vitamin B12 deficiency disorder. Diagnosis relies on cobalamin deficiency and antibodies to intrinsic factor. The management should focus on a possibly life-long replacement treatment with cobalamin. PMID:26306021
Full Text Available The usual dietary sources of Vitamin B12 are animal-derived foods, although a few plant-based foods contain substantial amounts of Vitamin B12. To prevent Vitamin B12 deficiency in high-risk populations such as vegetarians, it is necessary to identify plant-derived foods that contain high levels of Vitamin B12. A survey of naturally occurring plant-derived food sources with high Vitamin B12 contents suggested that dried purple laver (nori is the most suitable Vitamin B12 source presently available for vegetarians. Furthermore, dried purple laver also contains high levels of other nutrients that are lacking in vegetarian diets, such as iron and n-3 polyunsaturated fatty acids. Dried purple laver is a natural plant product and it is suitable for most people in various vegetarian groups.
Hvas, A M; Nexo, E; Nielsen, J B
Phenylketonuria (PKU) is caused by an autosomal recessive deficiency of the enzyme phelnylalanine hydroxylase leading to a failure to convert phenylalanine to tyrosine. To avoid irreversible neurological damage because of increased phenylalanine, treatment is instituted rapidly after birth. We examined 31 adult PKU patients living on a less protein-restricted diet. Theoretically, these PKU patients had an increased risk of developing vitamin B(12) and B(6) deficiency because of a limited intake of animal products. Besides laboratory tests (n = 31) we obtained clinical information (n = 30) and detailed information on food consumption (n = 28). Three-quarters of the patients had early biochemical signs of vitamin B(12) deficiency. In spite of a normal folate status, 9 (29%) had a plasma homocysteine above 12 micromol/L. In accord with these findings, the food questionnaires indicated that 11 (39%) patients received less than the recommended daily vitamin B(12), and 20 (71%) received less vitamin B(6) than recommended. A significant association was found between reduced vitamin B(12) intake and both reduced serum cobalamins (p = 0.04) and reduced serum transcobalamin saturation (p = 0.03). Eleven patients took a vitamin pill daily, and these patients had a significantly lower plasma homocysteine compared to the rest. The present study suggests that adult PKU patients were at increased risk of developing vitamin B(12) deficiency, and their intake of vitamin B(6) was below the recommended daily intake. In conclusion PKU patients need continuing dietary guidance throughout adult life, and considering the risks, costs and potential benefits, daily vitamin supplementation seems justified in these patients. PMID:16601867
Nodera, Hiroyuki; Izumi, Yuishin; Kaji, Ryuji
Vitamin B(12)(vB(12)) deficient is regarded as iatrogenic in some cases. Although the recommended oral intake of vB(12) has been determined, administration of vB(12) exceeding the recommended dose could have multiple pharmacological effects. "Ultra-high dose" vB(12) therapy has been used for peripheral neuropathy and amyotrophic lateral sclerosis, suggesting its promising neuroprotective effects. PMID:26329154
Romain, M; Sviri, S; Linton, D M; Stav, I; van Heerden, P V
Vitamin B12 is an essential micronutrient, as humans have no capacity to produce the vitamin and it needs to be ingested from animal proteins. The ingested Vitamin B12 undergoes a complex process of absorption and assimilation. Vitamin B12 is essential for cellular function. Deficiency affects 15% of patients older than 65 and results in haematological and neurological disorders. Low levels of Vitamin B12 may also be an independent risk factor for coronary artery disease. High levels of Vitamin B12 are associated with inflammation and represent a poor outlook for critically ill patients. Treatment of Vitamin B12 deficiency is simple, but may be lifelong. PMID:27456173
Leishear, K; Boudreau, RM; Studenski, SA; Ferrucci, L.; Rosano, C.; De Rekeneire, N; Houston, DK; Kritchevsky, SB; Schwartz, AV; Vinik, AI; Hogervorst, E.; Yaffe, K.; Harris, TB; Newman, AB; Strotmeyer, ES
OBJECTIVES: To examine whether deficient B12 status or low serum B12 levels are associated with worse sensory and motor peripheral nerve function in older adults. DESIGN: Cross-sectional. SETTING: Health, Aging and Body Composition Study. PARTICIPANTS: Two thousand two hundred and eightyseven adults aged 72 to 83 (mean 76.5 ±2.9; 51.4% female; 38.3% black). MEASUREMENTS: Low serum B12 was defined as serum B12 less than 260 pmol/L, and deficient B12 status was defined as B12 less than 260 pmol...
Nielsen, Marianne J; Rasmussen, Mie R; Andersen, Christian B F;
Vitamin B(12) (B(12); also known as cobalamin) is a cofactor in many metabolic processes; deficiency of this vitamin is associated with megaloblastic anaemia and various neurological disorders. In contrast to many prokaryotes, humans and other mammals are unable to synthesize B(12). Instead, a...... transport pathway are also known culprits of functional B(12) deficiency. Biochemical and genetic approaches have identified novel proteins in the B(12) transport pathway--now known to involve more than 15 gene products--delineating a coherent pathway for B(12) trafficking from food to the body's cells...
Burman, J. F.; Jenkins, W. J.; Walker-Smith, J A; Phillips, A D; Sourial, N A; Williams, C B; Mollin, D. L.
A Syrian family is described with three children who had inherited selective vitamin B12 malabsorption associated with proteinuria. (Imerslund-Grasbeck syndrome). Although inherited the defect was apparently not present at birth. A third child had less severe vitamin B12 malabsorption, was not vitamin B12 deficient and had no proteinuria. Studies on two of the affected children with subcellular fractionation of the uptake of radioactive vitamin B12 by ileal tissue in vivo indicate a defect in...
A radioassay is described for vitamin B12 which involves denaturing serum protein binding proteins with alkali. In the denaturation step a dithiopolyol and cyanide are used and in the intrinsic factor assay step a vitamin B12 analogue such as cobinamide is used to bind with any remaining serum proteins. The invention also includes a kit in which the dithiopolyol is provided in admixture with the alkali. The dithiopolyol may be dithiothreitol or dithioerythritol. (author)
Birn, Henrik; Willnow, Thomas E; Nielsen, Rikke;
Megalin has previously been shown to bind and mediate endocytosis of transcobalamin (TC)-B(12). However, the physiological significance of this has not been established, and other TC-B(12) binding proteins have been suggested to mediate renal uptake of this vitamin complex. The present study...... demonstrates by the use of megalin-deficient mice that megalin is, in fact, essential for the normal renal reabsorption of TC-vitamin B(12) and for renal accumulation of this highly conserved vitamin. Megalin-deficient mice excrete increased amounts of TC and B(12) in the urine, revealing a defective renal...... tubular uptake of TC-B(12). The urinary B(12) excretion is increased approximately 4-fold, resulting in an approximately 28-fold higher renal B(12) clearance. This is associated with an approximately 4-fold decrease in B(12) content in megalin-deficient kidney cortex. Thus megalin is important to prevent...
Moretti Rita; Torre Paola; Antonello Rodolfo; Cattaruzza Tatiana; Cazzato Giuseppe; Bava Antonio
In cross-sectional studies, low levels of folate and B12 have been shown to be associated with cognitive decline and dementia Evidence for the putative role of folate, vitamin B12 in neurocognitive and other neurological functions comes from reported cases of severe vitamin deficiencies, particularly pernicious anemia, and homozygous defects in genes that encode for enzymes of one-carbon metabolism. The neurological alterations seen in these cases allow for a biological role of vitamins in ne...
Arpita Patel; Chandan Chakrabarty; Arjun Singh; Jatin Patel; Hitesh Mewada; S L Sharma
Vitamin B12, folic acid and homocysteine are metabolically closely related. At the same time homocysteine is found to be offending factor for vascular pathology causing preeclampsia. On the other hand periconceptional nutritional status influences the vitamin B12 & folic acid level. Which further affect the homocysteine level thus may affect pregnancy outcome. Various contributory factors lead these vitamin deficiencies, maternal nutrition is one of them. Ahmedabad being a predominantly veget...
Schilling tests were performed in ten children aged 5-12 years suffering from homozygous β-thalassemia. 57Co labelled vitamin B12 values excreted in the urine have been found much lower than normal and remained low when the same procedure was repeated with the addition of intrinsic factor. The possible factors responsible for this malabsorption of vitamin B12 seemed to be liver damage and folic acid deficiency. (orig.)
Objective: To explore the changes of serum SF, FA and VitB12 levels after transfusion of preserved red cells in patients with IDA. Methods: Serum SF, FA and VitB12 levels (with RIA) were detected both before and after transfusion of preserved red cells in 32 patients with IDA as well as in 35 controls. Results: Before transfusion of preserved red cells, the serum SF levels were significantly lower than those in controls (P12 levels were significantly higher (P12 were not much different from those in the controls. Conclusion: Transfusion of preserved red cells proves to be very useful. (authors)
Smith, Mark H.; Woods, Sandra L.
Vitamin B12, reduced by titanium (III) citrate to vitamin B12s, catalyzes the reductive dechlorination of chlorophenols. Reductive dechlorination of pentachlorophenol and of all tetrachlorophenol and trichlorophenol isomers was observed. Reaction of various chlorophenols with vitamin B12 favored reductive dechlorination at positions adjacent to another chlorinated carbon, but chlorines ortho to the hydroxyl group of a phenol were particularly resistant to reductive dechlorination, even if the...
Kerek, R; Geoffroy, A.; Bison, A; Martin, N.; Akchiche, N; Pourié, G; Helle, D; Guéant, J-L; Bossenmeyer-Pourié, C; Daval, J-L
The methyl donors folate (vitamin B9) and vitamin B12 are centrepieces of the one-carbon metabolism that has a key role in transmethylation reactions, and thus in epigenetic and epigenomic regulations. Low dietary intakes of folate and vitamin B12 are frequent, especially in pregnant women and in the elderly, and deficiency constitutes a risk factor for various diseases, including neurological and developmental disorders. In this respect, both vitamins are essential for normal brain developme...
Moatassem S. Amer, MD
Conclusion: The prevalence of vitamin B12 deficiency was higher in the control group than the diabetic group who did not receive oral B12 supplementation. Low serum vitamin B12 is commonly overlooked in the elderly, with or without diabetes. The presence of diabetes mellitus did not affect BMD in the elderly. Furthermore, there is no significant relationship between serum vitamin B12 levels and BMD among diabetics.
Full Text Available Abstract Background Periprosthetic osteolysis is a major cause of aseptic loosening in joint arthroplasty. This study investigates the impact of CT (calcitonin deficiency and CT substitution under in-vivo circumstances on particle-induced osteolysis in Calca -/- mice. Methods We used the murine calvarial osteolysis model based on ultra-high molecular weight polyethylene (UHMWPE particles in 10 C57BL/6J wild-type (WT mice and twenty Calca -/- mice. The mice were divided into six groups: WT without UHMWPE particles (Group 1, WT with UHMWPE particles (Group 2, Calca -/- mice without UHMWPE particles (Group 3, Calca -/- mice with UHMWPE particles (Group 4, Calca -/- mice without UHMWPE particles and calcitonin substitution (Group 5, and Calca -/- mice with UHMWPE particle implantation and calcitonin substitution (Group 6. Analytes were extracted from serum and urine. Bone resorption was measured by bone histomorphometry. The number of osteoclasts was determined by counting the tartrate-resistant acid phosphatase (TRACP + cells. Results Bone resorption was significantly increased in Calca -/- mice compared with their corresponding WT. The eroded surface in Calca -/- mice with particle implantation was reduced by 20.6% after CT substitution. Osteoclast numbers were significantly increased in Calca -/- mice after particle implantation. Serum OPG (osteoprotegerin increased significantly after CT substitution. Conclusions As anticipated, Calca -/- mice show extensive osteolysis compared with wild-type mice, and CT substitution reduces particle-induced osteolysis.
Deficiencies of folate or of vitamin B-12 are widespread and constitute a major global burden of morbidity that affect all age groups. Detecting or confirming the presence of folate or vitamin B-12 deficiency and distinguishing one from the other depends, ultimately, on laboratory testing. Tests to determine the presence of folate or vitamin B-12 deficiency are used singly or in combination to establish the nutritional status and prevalence of deficiencies of the vitamins in various populatio...
Ebere C. Anyanwu; Ijeoma Kanu
A majority of patients with neurological disorders with chronic exposures to toxigenic molds and mycotoxins has vitamin B12 deficiency that is unrelated to dietary insufficiency. Vitamin B12 is a source of coenzymes, and participates in intracellular recycling of methionine, and in methionine synthase reactions. The biochemical processes that lead to B12 depletion and deficiency are not fully understood. This paper examines and assesses various most likely biochemical reasons that could imped...
A method is described for preparing radioactively labelled vitamin B 12 (cyanocobalamin) by reacting α-(5,6-dimethylbenzimidazolyl) hydrogenobamide with active (sup(57,58)Co) cobaltous ion. The latter may be in the form of cobaltous chloride or sulphate in aqueous or aqueous alcoholic medium. The reaction is effected by heating the reactants in darkness at pH 4 to 8. An excess of cyanide is added to convert the hydroxocobalamin formed to cyanocobalamin. (U.K.)
Full Text Available In cross-sectional studies, low levels of folate and B12 have been shown to be associated with cognitive decline and dementia Evidence for the putative role of folate, vitamin B12 in neurocognitive and other neurological functions comes from reported cases of severe vitamin deficiencies, particularly pernicious anemia, and homozygous defects in genes that encode for enzymes of one-carbon metabolism. The neurological alterations seen in these cases allow for a biological role of vitamins in neurophysiology. Results are quite controversial and there is an open debate in literature, considering that the potential and differential role of folate and B12 vitamin in memory acquisition and cognitive development is not completely understood or accepted. What is not clear is the fact that vitamin B12 and folate deficiency deteriorate a pre-existing not overt pathological situation or can be dangerous even in normal subjects. Even more intriguing is the interaction between B12 and folate, and their role in developing hyperhomocysteinemia. The approach to the rehabilitation of the deficiency with adequate vitamin supplementation is very confusing. Some authors suggest it, even in chronic situations, others deny any possible role. Starting from these quite confusing perspectives, the aim of this review is to report and categorize the data obtained from the literature. Despite the plausible biochemical mechanism, further studies, based on clinical, neuropsychological, laboratory and (lastly pathological features will be necessary to better understand this fascinating biochemical riddle.
Reasons to fortify flour with vitamin B12 are considered, which include the high prevalence of depletion and deficiency of this vitamin that occurs in persons of all ages in resource-poor countries and in elderly in wealthier countries, as well as the adverse functional consequences of poor vitamin ...
Dangour, AD; Allen, E; Clarke, R.; Elbourne, D; Fletcher, Ae; Letley, L.; Richards, M; Whyte, K.; Uauy, R.; Mills, K
BACKGROUND: Moderate vitamin B-12 deficiency is relatively common in older people. However, there is little robust evidence on the effect of vitamin B-12 supplementation on neurologic and cognitive outcomes in later life. OBJECTIVE: We investigated whether vitamin B-12 supplementation benefits neurologic and cognitive function in moderately vitamin B-12-deficient older people. DESIGN: We conducted a double-blind, randomized, placebo-controlled trial in 7 general practices in South East Englan...
The authors compared four radioisotope dilution (RD) methods and a microbiological assay for measuring concentrations of vitamin B12 in a selected panel of serum samples from patients known to be deficient in the vitamin. Low (less than 100 ng/L) and borderline (100-180 ng/L) results were similar between methods, but use of the manufacturers recommended ranges for borderline results would have changed the diagnostic classifications for 22 of 38 samples. Results of all the RD methods inter-correlated well, but less so with the microbiological assay. Borderline, nondiagnostic results were common to all methods, and no apparent advantage was gained from using the microbiological assay
Duggan, Christopher; Srinivasan, Krishnamachari; Thomas, Tinku; Samuel, Tinu; Rajendran, Ramya; Muthayya, Sumithra; Finkelstein, Julia L; Lukose, Ammu; Fawzi, Wafaie; Allen, Lindsay H.; Bosch, Ronald J.; Kurpad, Anura V
Pregnant women in resource-poor areas are at risk of multiple micronutrient deficiencies, and indicators of low vitamin B-12 status have been associated with adverse pregnancy outcomes, including anemia, low birth weight, and intrauterine growth retardation. To evaluate whether daily oral vitamin B-12 supplementation during pregnancy increases maternal and infant measures of vitamin B-12 status, we performed a randomized, placebo-controlled clinical trial. Pregnant women
Based on the high prevalence of low serum vitamin B-12 concentrations and low dietary intake of the vitamin in Latin American studies including research in Mexico, it appears that vitamin B-12 deficiency is common. Whether this is associated with adverse effects on human function is unknown. To eval...
Bain, Barbara; Broom, GN; Woodside, Jackie; Litwinczuk, RA; Wickramasinghe, SN
A competitive protein binding radioassay kit for serum vitamin B12 has been assessed. Precision, linearity, sensitivity, and specificity have been found to be satisfactory. Falsely-normal assay results in patients with vitamin B12 deficiency have not been observed.
Full Text Available Vitamin B12, folic acid and homocysteine are metabolically closely related. At the same time homocysteine is found to be offending factor for vascular pathology causing preeclampsia. On the other hand periconceptional nutritional status influences the vitamin B12 & folic acid level. Which further affect the homocysteine level thus may affect pregnancy outcome. Various contributory factors lead these vitamin deficiencies, maternal nutrition is one of them. Ahmedabad being a predominantly vegetarian city, its population is at higher risk of vitamin B12 deficiency. But no systematic study has been done in Ahmedabad to know whether B12, folic acid and homocysteine levels influence pregnancy. To know this answer this study was planned to know total homocysteine level and its correlation in preeclampsia and normotensive pregnant women.Vitamin B12, folic acid and homocysteine were measured in all the subjects using fluorescence polarized immunoassay in AxSym Immunochemistry analyzer on 60 non vitamin supplemented vegetarian women. Vitamin levels were within lower normal limit. Homocysteine level was higher among preeclampsia patient. From the findings of the present study it can be concluded that measurement of these biochemical parameter in ante natal care are useful for further management and prevention of complication of pregnancy like preeclampsia
Greibe, E; Miller, J. W.; Foutouhi, S H; Green, R.; Nexo, E.
AIMS/HYPOTHESIS: Patients treated with metformin exhibit low levels of plasma vitamin B(12) (B(12)), and are considered at risk for developing B(12) deficiency. In this study, we investigated the effect of metformin treatment on B(12) uptake and distribution in rats.METHODS: Sprague Dawley rats (n = 18) were divided into two groups and given daily subcutaneous injections with metformin or saline (control) for three weeks. Following this, the animals received an oral dose of radio-labeled B(12...
... be limited. Home Visit Global Sites Search Help? Vitamin B12 and Folate Share this page: Was this ... as: Cobalamin; Folic Acid; RBC Folate Formal name: Vitamin B12; Folate Related tests: Complete Blood Count , Methylmalonic ...
Almholt, Kasper; Lund, L.R.; Rygaard, Jørgen; Nielsen, Boye Schnack; Danø, Keld; Nielsen, John Rømer; Johnsen, Morten
A prominent phenotype of plasmin deficiency in mice is reduced metastasis in the MMTV-PymT transgenic breast cancer model. Proteolytically active plasmin is generated from inactive plasminogen by one of 2 activators, uPA or tPA. We now find that uPA deficiency alone significantly reduces metastasis...... >7-fold in the MMTV-PymT model. We studied a cohort of 55 MMTV-PymT transgenic mice, either uPA-deficient or wild-type controls. Tumor incidence, latency, growth rate and final primary tumor burden were not significantly affected by uPA deficiency. In contrast, average lung metastasis volume was...
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Doets, Esmee; Groot, de C.P.G.M.
This paper provides an overview of dose-response evidence relevant for estimating vitamin B12 requirements of healthy adults and elderly people, considering different indicators of health: vitamin B12 body stores, cognitive function, bone health, and biomarkers of vitamin B12 status.
Grabellus Florian; Hilken Gero; Broecker-Preuss Martina; Neuerburg Laura; Bachmann Hagen S; Kauther Max D; Koehler Gabriele; von Knoch Marius; Wedemeyer Christian
Abstract Background Periprosthetic osteolysis is a major cause of aseptic loosening in joint arthroplasty. This study investigates the impact of CT (calcitonin) deficiency and CT substitution under in-vivo circumstances on particle-induced osteolysis in Calca -/- mice. Methods We used the murine calvarial osteolysis model based on ultra-high molecular weight polyethylene (UHMWPE) particles in 10 C57BL/6J wild-type (WT) mice and twenty Calca -/- mice. The mice were divided into six groups: WT ...
Mahajan, R; Gupta, K
Monitoring of adverse drug reactions of a drug is a continuous process and runs through-out the life of a drug. Many rare adverse effects of a drug are documented after years of use; when a single case (signal generation) is reported leading subsequently to reporting of more cases. Deficiency of Vitamin B12 (vit B(12)) is a known sequel of prolonged metformin therapy. It was recommended to have annual measurement of serum vit B(12) levels in patients on long term metformin therapy way back in 1970 itself. After more than 50 years of use of metformin, we have come to know that metformin induced vit B(12) deficiency can cause neuropathy; forcing to change the recommendation from annual screening of vit B(12) levels to annual supplementation of vit B(12). PMID:21264109
Andrews Liggy, Tintu Thomas , Haridas Nambudiri
Full Text Available Introduction: Vitamin B12 deficiency usually presents with pernicious anemia or various neuropsychiatric manifestations such as neuropathy, myelopathy, dementia, cerebellar ataxia, optic atrophy, pscyhosis and mood disorders. Hence vitamin B12 deficiency should be identified. The local population in our area mainly comprises of vegetarians, this study was initiated with a view to assess their B12 status early, to rule out its deficiency and help to prevent further complications. Methodology: We analyzed serum B12 levels in 396 cases by competitive chemiluminescent immunometric method using Immulite instrument. Result: It was found that B12 levels were significantly low in 260(65.6% patients (P<0.000. Majority 225 (86.5% of the deficient patients were vegetarians and the deficiency was found less in non vegetarians (P<0.000. The B12 deficiency was evident more in patients below 50years (199 out of 396 i.e. 76.5% of age as compared to those who are above 51 years of age (60 out of 396 i.e. 23.4%, with a P value <0.000. The deficiency was prevalent more in females 179 (68.8% in comparison to males 81(31.1% and the P<0.000. Our study found that B12 deficiency is quiet prevalent in local population (65.6%, the condition being worse in females. And it was also noticed that deficiency was relatively more in vegetarians. Conclusion: The early detection of B12 deficiency could help in warding off the resultant complications.
Eltweri, Amar M.; Bowrey, David J.; Christopher D Sutton; Graham, Lisa; Williams, Robert N
Abstract Sleeve gastrectomy has increased in popularity over the last five years and it is likely to supersede gastric banding. Nevertheless, it is unclear whether vitamin B12 supplementation is required after surgery. The aim of this short report is to identify any vitamin B12 deficiency and highlight the necessity of post laparoscopic sleeve gastrectomy vitamin B12 monitoring. Patients and methods A review of 66 patients underwent LSG in our institution. 25 patients were excluded as they ha...
Since the introduction of folic acid fortification of flour 10 y ago, an initiative to consider fortifying flour with vitamin B-12 has gained momentum in the United States. The impetus for this move stems from several considerations, including some evidence that a proportion of neural tube defect pregnancies may be the result of vitamin B-12 rather than folate deficiency. However, no interventional trials have taken place to show the efficacy of vitamin B-12 supplementation or fortification i...
Imerslund-Gräsbeck syndrome (IGS) or selective vitamin B12 (cobalamin) malabsorption with proteinuria is a rare autosomal recessive disorder characterized by vitamin B12 deficiency commonly resulting in megaloblastic anemia, which is responsive to parenteral vitamin B12 therapy and appears in childhood. Other manifestations include failure to thrive and grow, infections and neurological damage. Mild proteinuria (with no signs of kidney disease) is present in about half of the patients. Anatom...
Subedi, Harishchandra; Brasch, Nicola E
There is accumulating evidence for the existence of HNO in biological systems. Compared with NO (˙NO), much less is known about the chemical and biochemical reactivity of HNO. Kinetic and mechanistic studies have been carried out on the reaction between the vitamin B12-derived radical complex cob(II)alamin (Cbl(II)˙, Cbl(II)) with the widely used HNO donor Piloty's acid (PA). A stoichiometry of 1 : 2 Cbl(II) : PA was obtained and PA decomposition to HNO and benzenesulfinate (C6H5SO2(-)) is the rate-determining step. No evidence was found for nitrite (Griess assay), ammonia (Nessler's test) or NH2OH (indooxine test) in the product solution, and it is likely that HNO is instead reduced to N2. A mechanism is proposed in which reduction of Cbl(II) by (H)NO results in formation of cob(I)alamin (Cbl(I)(-)) and ˙NO. The Cbl(I)(-) intermediate is subsequently oxidized back to Cbl(II) by a second (H)NO molecule, and Cbl(II) reacts rapidly with ˙NO to form nitroxylcobalamin (NOCbl). Separate studies on the reaction between Cbl(I)(-) and PA shows that this system involves an additional step in which Cbl(I)(-) is first oxidized by (H)NO to Cbl(II), which reacts further with (H)NO to form NOCbl, with an overall stoichiometry of 1 : 3 Cbl(I)(-) : PA. Experiments in the presence of nitrite for both systems support the involvement of a Cbl(I)(-) intermediate in the Cbl(II)/PA reaction. These systems provide the second example of oxidation of cob(I)alamin by (H)NO. PMID:26618754
Radioassay for vitamin B-12 using the unknown quantity of non-radioactive vitamin B-12 released from serum mixed with the radioactivity of a known quantity of radioactive vitamin B-12 tracer. A solution of intrinsic factor having a binding capacity less than the quantity of serum vitamin B-12 and radioactive vitamin B-12 is used to bind a portion of the vitamin B-12 mixture. The vitamin B-12 not bound to intrinsic factor is removed by addition of a bentonite-containing tablet. The quantity of radioactive vitamin B-12 bound to intrinsic factor is compared with standard values and the unknown serum vitamin B-12 obtained. In the steps of the procedure the acid assay medium is pre-combined with the radioactive tracer so that the radioactive vitamin B-12 tracer receives the same treatment as serum vitamin B-12. Certain of the other reagent solutions are pre-combined and the concentration of the components adjusted so that the volume used of each of these other reagent solutions is the same in different assay steps. Thus, fewer pipetting steps are necessary. 7 claims, 1 drawing figure