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Amado-Garzon SB, Molina-Pimienta L, Vejarano-Pombo A, Vélez-Bonilla M, Moreno-Chaparro J, Buitrago-Lopez A. Elevated Vitamin B12, Risk of Cancer, and Mortality: A Systematic Review. Cancer Invest 2024; 42:515-526. [PMID: 38953509 DOI: 10.1080/07357907.2024.2366907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/08/2024] [Indexed: 07/04/2024]
Abstract
Vitamin B12 (B12) is a molecule involved in several biological. Abnormally high levels are frequently found, but their causes can be multiple, and consequences have not been clearly elucidated. The objective of this review was to summarize the current evidence on the associations of elevated B12 and the development of cancer, and all-cause mortality in adults. Six references looking at mortality and seven looking at cancer risk were included. The evidence suggests an association between elevated B12 with a higher risk of cancer, with risk ratios ranging 1,88 to 5,9. There was less consistent evidence linking vitamin B12 and mortality.
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Affiliation(s)
- Sandra B Amado-Garzon
- Department of Internal Medicine at Hospital Universitario San Ignacio. Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, D.C. Colombia
| | - Luisana Molina-Pimienta
- Department of Internal Medicine at Hospital Universitario San Ignacio. Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, D.C. Colombia
| | - Andrea Vejarano-Pombo
- Department of Internal Medicine at Hospital Universitario San Ignacio. Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, D.C. Colombia
| | - Mariana Vélez-Bonilla
- Department of Internal Medicine at Hospital Universitario San Ignacio. Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, D.C. Colombia
| | - Jaime Moreno-Chaparro
- Department of Clinical Epidemiology and Biostatistics. Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, D.C. Colombia
| | - Adriana Buitrago-Lopez
- Department of Clinical Epidemiology and Biostatistics. Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, D.C. Colombia
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The Controversial Role of HCY and Vitamin B Deficiency in Cardiovascular Diseases. Nutrients 2022; 14:nu14071412. [PMID: 35406025 PMCID: PMC9003430 DOI: 10.3390/nu14071412] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 11/16/2022] Open
Abstract
Plasma homocysteine (HCY) is an established risk factor for cardiovascular disease CVD and stroke. However, more than two decades of intensive research activities has failed to demonstrate that Hcy lowering through B-vitamin supplementation results in a reduction in CVD risk. Therefore, doubts about a causal involvement of hyperhomocysteinemia (HHcy) and B-vitamin deficiencies in atherosclerosis persist. Existing evidence indicates that HHcy increases oxidative stress, causes endoplasmatic reticulum (ER) stress, alters DNA methylation and, thus, modulates the expression of numerous pathogenic and protective genes. Moreover, Hcy can bind directly to proteins, which can change protein function and impact the intracellular redox state. As most mechanistic evidence is derived from experimental studies with rather artificial settings, the relevance of these results in humans remains a matter of debate. Recently, it has also been proposed that HHcy and B-vitamin deficiencies may promote CVD through accelerated telomere shortening and telomere dysfunction. This review provides a critical overview of the existing literature regarding the role of HHcy and B-vitamin deficiencies in CVD. At present, the CVD risk associated with HHcy and B vitamins is not effectively actionable. Therefore, routine screening for HHcy in CVD patients is of limited value. However, B-vitamin depletion is rather common among the elderly, and in such cases existing deficiencies should be corrected. While Hcy-lowering with high doses of B vitamins has no beneficial effects in secondary CVD prevention, the role of Hcy in primary disease prevention is insufficiently studied. Therefore, more intervention and experimental studies are needed to address existing gaps in knowledge.
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Chen Y, Luo R, King M, Shi Q, He J, Hu Z. Spatiotemporal analysis of crash severity on rural highway: A case study in Anhui, China. ACCIDENT; ANALYSIS AND PREVENTION 2022; 165:106538. [PMID: 34922106 DOI: 10.1016/j.aap.2021.106538] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/30/2021] [Accepted: 12/07/2021] [Indexed: 06/14/2023]
Abstract
Traffic crashes are the result of the interaction between human activities and different socio-economic, geographical, and environmental factors, showing a temporal and spatial relationship. The temporal and spatial correlations must be characterized in crash severity studies, for which the geographically and temporally weighted ordered logistic regression (GTWOLR) model is an effective approach. However, existing studies using the GTWOLR model only subjectively selected a type of kernel function and kernel bandwidth, which cannot determine the best expression of the spatiotemporal relationship between crashes. This paper explores the optimal kernel function and kernel bandwidth considering the aforementioned problem to obtain the best GTWOLR model to analyze the crash data based on the crash data of rural highways in Anhui Province, China, from 2014 to 2017. First, the GTWOLR models with Gaussian or Bi-square kernel function and fixed (the spatiotemporal distance remains constant of local sample) or adaptive (the quantity of the local sample is constant) bandwidth are compared. Second, the log-likelihood and Akaike information criterion are used to compare the GTWOLR model with the ordered logistic regression (OLR) model. Finally, the spatial and temporal characteristics of the contributing factors in the best GTWOLR model are analyzed, and corresponding countermeasures for improving traffic safety on rural highways are proposed. Model comparison results reveal that although the difference was insignificant, the Bi-square kernel function with fixed bandwidth (BF)- GTWOLR model has a better goodness of fit than the GTWOLR models with other types of kernel function and bandwidth and the OLR model. The BF-GTWOLR model estimation results showed that eight factors, including pedestrian-vehicle crash, middle-aged driver, hit-and-run, truck, motorcycle, curve, slope and mountainous, passed the non-stationary test, indicating their varying effects on the crash severity across space and over time. As a crash severity modeling approach that effectively quantifies the spatiotemporal relationships in crashes, the BF-GTWOLR model, which adapts to crash data, may have implications for future research. In addition, the findings of this paper can help traffic management departments to propose progressive and targeted policies or countermeasures, so as to reduce the severity of rural highway crashes.
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Affiliation(s)
- Yikai Chen
- School of Automotive and Transportation Engineering, Hefei University of Technology, Hefei, Anhui, China.
| | - Renjia Luo
- School of Automotive and Transportation Engineering, Hefei University of Technology, Hefei, Anhui, China; Anhui Provincial Traffic Survey and Design Institute Co., Hefei, Anhui, China.
| | - Mark King
- Centre for Accident Research and Road Safety-Queensland, Queensland University of Technology (QUT), Brisbane, Queensland, Australia.
| | - Qin Shi
- School of Automotive and Transportation Engineering, Hefei University of Technology, Hefei, Anhui, China
| | - Jie He
- School of Transportation, Southeast University, Nanjing, Jiangsu, China
| | - Zongpin Hu
- School of Automotive and Transportation Engineering, Hefei University of Technology, Hefei, Anhui, China
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Abstract
BACKGROUND There is conflicting evidence in the literature on the association between (elevated) serum B12 concentrations and subsequent disease or mortality. We evaluated in the NHANES general population the association of serum B12 concentrations as well as vitamin B12 supplement intake with all-cause, cardiovascular, and cancer-related mortality, while taking into account demographic and lifestyle factors and significant other diseases which are known to be associated with poorer outcome. METHODS The main outcomes of our study were all-cause mortality, cardiovascular mortality, and cancer-related mortality. Mortality status and cause of death were determined by NHANES-linked National Death Index public access files through December 31, 2015. The association of serum B12 concentrations and vitamin B12 supplement intake with mortality was assessed with Cox proportional hazard (PH) models, with adjustment for a number of relevant demographic and lifestyle factors and comorbidity. RESULTS The final study population of 24,262 participants had a mean age of 48 (SD 19) years; 50.1% were males. The median follow-up duration was 109 months (range 1-201 months). On the census day of December 31, 2015, 3023 participants were determined as deceased (12.5%). The fully adjusted Cox PH model indicated that low serum B12 concentrations < 140 pmol/l were associated with a small increase in all-cause (hazard ratio, HR 1.39, 95% CI 1.08-1.78, p = 0.011) and cardiovascular (HR 1.64, 95% CI 1.08-2.47, p = 0.020) mortality. Similarly, high serum B12 concentrations > 700 pmol/l were associated with an increase in cardiovascular mortality only (HR 1.45, 95% CI 1.01-2.06, p = 0.042). Participants with a diagnosis of hypertension, dyslipidemia, CVD, and cancer more frequently used vitamin B12-containing supplements than those without these diagnoses. We could not demonstrate an association between vitamin B12 supplement intake and mortality, when adjusted for comorbidity. CONCLUSIONS In the general population of NHANES, low serum B12 concentrations were associated with a moderate increase in all-cause mortality. There was a small but significant increase in cardiovascular mortality in the groups with low or high serum B12. High intake of vitamin B12 in the form of supplements was not associated with any adverse effect on mortality and therefore can be regarded as safe.
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Flores-Guerrero JL, Minović I, Groothof D, Gruppen EG, Riphagen IJ, Kootstra-Ros J, Muller Kobold A, Hak E, Navis G, Gansevoort RT, de Borst MH, Dullaart RPF, Bakker SJL. Association of Plasma Concentration of Vitamin B12 With All-Cause Mortality in the General Population in the Netherlands. JAMA Netw Open 2020; 3:e1919274. [PMID: 31940038 PMCID: PMC6991261 DOI: 10.1001/jamanetworkopen.2019.19274] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Higher plasma concentrations of vitamin B12 have been associated with mortality in elderly and hospitalized populations, including patients with chronic kidney disease, but the association of plasma concentrations of vitamin B12 with mortality in the general population remains unclear. OBJECTIVE To investigate the association of plasma concentrations of vitamin B12 with all-cause mortality. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cohort study used post hoc analysis to examine data from participants of the Prevention of Renal and Vascular End-stage Disease Study in Groningen, the Netherlands. Participants included individuals who completed the second screening visit beginning January 1, 2001, excluding those who were missing values of vitamin B12 plasma concentrations or used vitamin B12 supplementation. Follow-up time was defined between the beginning of the second screening round to end of follow-up on January 1, 2011. Data analysis was conducted from October 2, 2018, to February 22, 2019. EXPOSURES Plasma vitamin B12 concentration level. MAIN OUTCOMES AND MEASURES Death as recorded by the Central Bureau of Statistics of Groningen, the Netherlands. RESULTS A total of 5571 participants (mean [SD] age, 53.5 [12.0] years; 2830 [50.8%] men) were included in analyses. Median (interquartile range) plasma concentration of vitamin B12 was 394.42 (310.38-497.42) pg/mL. During the median (interquartile range) of 8.2 (7.7-8.9) years of follow-up, 226 participants (4.1%) died. According to quartiles of the distribution of plasma vitamin B12 concentration levels, mortality rates were 33.8 deaths per 10 000 person-years for the quartile with the lowest plasma concentration of vitamin B12 and 65.7 deaths per 10 000 person-years for the quartile with the highest plasma concentration of vitamin B12. After adjustment for multiple clinical and laboratory variables, Cox regression analyses found a significant association between higher vitamin B12 plasma concentration level and increased risk of all-cause mortality (hazard ratio per 1-SD increase, 1.25 [95% CI, 1.06-1.47]; P = .006). CONCLUSIONS AND RELEVANCE These findings suggest that higher levels of plasma concentrations of vitamin B12 were associated with increased risk of all-cause mortality after adjusting for age, sex, renal function, and other clinical and laboratory variables. The mechanisms underlying this association remain to be established.
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Affiliation(s)
- Jose L. Flores-Guerrero
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Isidor Minović
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
- University Medical Center Groningen, Department of Laboratory Medicine, University of Groningen, Groningen, the Netherlands
| | - Dion Groothof
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Eke G. Gruppen
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Ineke J. Riphagen
- University Medical Center Groningen, Department of Laboratory Medicine, University of Groningen, Groningen, the Netherlands
| | - Jenny Kootstra-Ros
- University Medical Center Groningen, Department of Laboratory Medicine, University of Groningen, Groningen, the Netherlands
| | - Anneke Muller Kobold
- University Medical Center Groningen, Department of Laboratory Medicine, University of Groningen, Groningen, the Netherlands
| | - Eelko Hak
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, the Netherlands
| | - Gerjan Navis
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Ron T. Gansevoort
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Martin H. de Borst
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Robin P. F. Dullaart
- University Medical Center Groningen, Division of Endocrinology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
| | - Stephan J. L. Bakker
- University Medical Center Groningen, Division of Nephrology, Department of Internal Medicine, University of Groningen, Groningen, the Netherlands
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Pusceddu I, Herrmann W, Kleber ME, Scharnagl H, März W, Herrmann M. Telomere length, vitamin B12 and mortality in persons undergoing coronary angiography: the Ludwigshafen risk and cardiovascular health study. Aging (Albany NY) 2019; 11:7083-7097. [PMID: 31492825 PMCID: PMC6756881 DOI: 10.18632/aging.102238] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/22/2019] [Indexed: 11/25/2022]
Abstract
Background: Vitamin B12 (B12) deficiency and excess are associated with increased risk of age-related-diseases and mortality. It has been suggested that high- and low-B12 concentrations link to increased mortality through accelerated genomic aging and inflammation. Evidence to support this is limited. Results: B12 was associated with all-cause-mortality, RTL and hsCRP in a non-linear fashion. The association between B12 and mortality was not independent, as it lost significance after adjustment for potential confounders. In the lowest-(LB12) and highest-(HB12) quartiles of B12 mortality was higher than in the mid-range (HR:LB12:1.23;CI95%:1.06-1.43; HR:HB12:1.24;CI95%:1.06-1.44). We divided subjects with LB12 in quartiles of their RTL. Those with the longest-telomeres had a lower mortality-rate (HR:0.57;95%CI:0.39-0.83) and lower homocysteine than those with the shortest-telomeres. Amongst subjects with HB12, those with long-telomeres also had a lower mortality than those with short-telomeres (HR:0.40;95%CI:0.27-0.59). IL-6 and hsCRP concentrations were low in HB12LT but were high in HB12ST. Methods: B12, homocysteine, telomere length (RTL), interleukin-6 (IL-6) and high-sensitive-C-reactive-protein (hsCRP) were measured in 2970 participants of the LURIC study. Conclusions: Mortality, stratified according to B12 and RTL, seems to be driven by different mechanisms. In LB12 and HB12 subjects, mortality and accelerated telomere shortening might be driven by homocysteine and inflammation, respectively.
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Affiliation(s)
- Irene Pusceddu
- Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy
| | - Wolfgang Herrmann
- Department of Clinical Chemistry, University of Saarland, Homburg, Germany
| | - Marcus E Kleber
- Medical Clinic V - Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany
| | - Hubert Scharnagl
- Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria
| | - Winfried März
- Medical Clinic V - Nephrology, Hypertensiology, Rheumatology, Endocrinology, Diabetology, Medical Faculty of Mannheim, University of Heidelberg, Mannheim, Germany.,Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria.,Synlab Academy, Synlab Holding Deutschland GmbH, Mannheim, Germany
| | - Markus Herrmann
- Department of Clinical Pathology, Hospital of Bolzano, Bolzano, Italy.,Medical University of Graz, Clinical Institute of Medical and Chemical Laboratory Diagnostics, Graz, Austria
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Elevated Plasma Vitamin B12 Concentrations Are Independent Predictors of In-Hospital Mortality in Adult Patients at Nutritional Risk. Nutrients 2016; 9:nu9010001. [PMID: 28025528 PMCID: PMC5295045 DOI: 10.3390/nu9010001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 12/12/2016] [Accepted: 12/19/2016] [Indexed: 12/19/2022] Open
Abstract
Background: Elevated plasma vitamin B12 concentrations were identified as predictors of mortality in patients with oncologic, hepatic and renal diseases, and in elderly and critically ill medical patients. The association between vitamin B12 concentrations and in-hospital mortality in adult patients at nutritional risk has not been assessed. Methods: In this five-year prospective study, we investigated whether high vitamin B12 concentrations (>1000 pg/mL) are associated with in-hospital mortality in 1373 not-bed-ridden adult patients at nutritional risk (Nutrition Risk Index <97.5), admitted to medical and surgical departments. Results: Three hundred and ninety-six (28.8%) patients presented vitamin B12 > 1000 pg/mL. Two hundred and four patients died in the hospital (14.9%). The adjusted odds ratio of in-hospital mortality in patients with high vitamin B12 was 2.20 (95% CI, 1.56–3.08; p < 0.001); it was independent of age, gender, body mass index, six-month previous unintentional weight loss, admission ward, presence of malignancy, renal function, C-reactive protein and prealbumin. Patients with high vitamin B12 also had a longer length of stay (LOS) than those with normal concentrations (median 25 days, (IQR 15–41) versus 23 days (IQR 14–36); p = 0.014), and elevated vitamin B12 was an independent predictor of LOS (p = 0.027). Conclusions: An independent association between elevated vitamin B12 concentrations, mortality and LOS was found in our sample of hospitalized adult patients at nutritional risk. Although the underlying mechanisms are still unknown and any cause-effect relation cannot be inferred, clinicians should be aware of the potential negative impact of high vitamin B12 concentrations in hospitalized patients at nutritional risk and avoid inappropriate vitamin supplementation.
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Use of Electronic Health Record Data to Evaluate the Impact of Race on 30-Day Mortality in Patients Admitted to the Intensive Care Unit. J Racial Ethn Health Disparities 2016; 4:539-548. [PMID: 27324822 DOI: 10.1007/s40615-016-0256-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/03/2016] [Accepted: 06/07/2016] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The current body of literature examining the impact of race upon outcomes for patients admitted to the intensive care unit (ICU) is limited. The primary objective of our study was to explore this question using a large cohort drawn from an electronic health record (EHR)-based data source. METHODS We conducted a retrospective cohort study using Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-II), an EHR-derived database encompassing ICU admissions to an academic medical center in Boston, Massachusetts, between 2001 and 2008. Adults admitted to a medical or surgical ICU were assessed for the primary outcome of 30-day mortality and secondary outcomes of in-hospital mortality and hospital length-of-stay. Multivariate logistic regression was used to determine the association between race and the primary outcome. RESULTS The study cohort consisted of 14,684 adult ICU patients-10,562 White, 1311 Black, 363 Asian, 868 "Other," and 1580 without known race. Thirty-day mortality rates experienced by Black and Asian individuals were significantly lower than mortality among those identified as White, with odds ratios of 0.62 (95 % CI 0.50-0.77) and 0.64 (95 % CI 0.44-0.93), respectively. Patients without known race experienced the highest crude mortality overall (27.4 %) and twice the adjusted odds of mortality compared with the White group. CONCLUSIONS In a large, racially diverse cohort of general ICU patients, White patients experienced significantly higher mortality than non-White patients. Our results are consistent with findings from other studies that indicate that the non-White race does not appear to negatively impact short-term survival following ICU admission.
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