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Sohouli MH, Almuqayyid F, Alfardous Alazm A, Ziamanesh F, Izze da Silva Magalhães E, Bagheri SE, Rodrigues de Oliveira B, Alfardous Alazm M, Adi AR, Alomar S, Abu-Zaid A. A comprehensive review and meta-regression analysis of randomized controlled trials examining the impact of vitamin B12 supplementation on homocysteine levels. Nutr Rev 2024; 82:726-737. [PMID: 37495210 DOI: 10.1093/nutrit/nuad091] [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] [Indexed: 07/28/2023] Open
Abstract
CONTEXT Although some research suggests that vitamin B12 (hereafter, B12) supplements can lower homocysteine (Hcy) levels and treat hyperhomocysteinemia, these results are still ambiguous when B12 is taken as an isolated supplement. OBJECTIVE This study sought to determine how existing randomized controlled trials (RCTs) could be used to examine the effects of B12 supplementation on Hcy. DATA SOURCES To find pertinent RCTs up to June 2022, databases, including PubMed/Medline, Web of Science, Scopus, Cochrane Library, and Embase, were searched. DATA EXTRACTION All selected RCTs investigated the impact of B12 supplements on Hcy. A meta-analysis of the eligible studies was performed using the random-effects model. DATA ANALYSIS This review included a total of 21 RCTs (N = 1625 participants). Hcy levels were significantly lower after B12 supplementation compared with the control group (pooled weighted mean difference, -4.15 μmol/L; 95% confidence interval, -4.86, -3.45; P < 0.001), and this reduction was even greater with intervention durations ≥12 weeks and doses >500 µg/d. Furthermore, the effect of B12 supplementation in the form of hydroxocobalamin on the reduction of Hcy level was greater compared with other forms. CONCLUSION In conclusion, this meta-analysis shows that B12 supplementation has a positive impact on lowering blood Hcy levels, particularly when administered for a longer period and at a larger dose. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42022364066.
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Affiliation(s)
- Mohammad Hassan Sohouli
- Student Research Committee, Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Fateme Ziamanesh
- Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Elma Izze da Silva Magalhães
- Postgraduate Program in Food, Nutrition and Health, Department of Clinical Nutrition and Dietetics, Federal University of Rio Grande do Sul,São Luís, MA, Brazil
| | - Seyedeh Elaheh Bagheri
- Department of Epidemiology and Biostatistics, Tehran University of Medical Sciences, Tehran, Iran
| | - Bianca Rodrigues de Oliveira
- Postgraduate Program in Food, Nutrition and Health, Department of Clinical Nutrition and Dietetics, Federal University of Rio Grande do Sul,São Luís, MA, Brazil
| | | | | | - Sara Alomar
- Department of Family Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ahmed Abu-Zaid
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- College of Graduate Health Sciences, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Vincenti A, Bertuzzo L, Limitone A, D’Antona G, Cena H. Perspective: Practical Approach to Preventing Subclinical B12 Deficiency in Elderly Population. Nutrients 2021; 13:1913. [PMID: 34199569 PMCID: PMC8226782 DOI: 10.3390/nu13061913] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 12/11/2022] Open
Abstract
Vitamin B12 (also known as cobalamin) is an essential water-soluble vitamin that plays a pivotal role for several physiologic functions during one's lifespan. Only certain microorganisms are able to synthetize B12, thus humans obtain cobalamin exclusively from their diet, specifically from animal-derived foods. Specific sub-group populations are at risk of vitamin B12 subclinical deficiency due to different factors including poor intake of animal source foods and age-dependent decrease in the capacity of intestinal B12 uptake. Consumption of animal products produces some negative health issues and negatively impacts sustainability while a plant-based diet increases the risk of B12 deficiency. Taking a cue from the aforementioned considerations, this narrative review aims to summarize facts about B12 deficiency and the burden of inadequate dietary intake in elderly population, as well as to discuss sustainable approaches to vitamin B12 deficiency in aging population.
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Affiliation(s)
- Alessandra Vincenti
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
| | - Laura Bertuzzo
- Glaxosmithkline (GSK) Consumer Healthcare, via Zambeletti s.n.c., 20021 Baranzate, Italy; (L.B.); (A.L.)
| | - Antonio Limitone
- Glaxosmithkline (GSK) Consumer Healthcare, via Zambeletti s.n.c., 20021 Baranzate, Italy; (L.B.); (A.L.)
| | - Giuseppe D’Antona
- Centro di Ricerca Interdipartimentale nelle Attività Motorie e Sportive (CRIAMS)—Sport Medicine Centre, University of Pavia, 27058 Voghera, Italy;
| | - Hellas Cena
- Laboratory of Dietetics and Clinical Nutrition, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, 27100 Pavia, Italy;
- Clinical Nutrition and Dietetics Service, Unit of Internal Medicine and Endocrinology, ICS Maugeri IRCCS, 27100 Pavia, Italy
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Vitamin B12-fortified toothpaste improves vitamin status in elderly people: a randomized, double-blind, placebo-controlled study. Aging Clin Exp Res 2019; 31:1817-1825. [PMID: 30680547 DOI: 10.1007/s40520-019-01125-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Elderly people are at risk for vitamin B12 deficiency. AIMS We studied the ability of vitamin B12-enriched toothpaste vs. placebo to increase vitamin B12 status in elderly subjects. METHODS We conducted a randomized double-blind placebo-controlled intervention in 103 elderly subjects. Serum concentrations of vitamin B12, holotranscobalamin (holoTC), methylmalonic acid (MMA), and plasma total homocysteine (tHcy) were measured at baseline and after 3 months. RESULTS 92 subjects met the inclusion criteria, completed the 3 months study, and were included in the data analysis. After the intervention, concentrations of vitamin B12 were higher [mean (SD) = 368 (123) vs. 295 (123) pmol/L; p = 0.005] and holoTC tended to be higher [112 (48) vs. 91 (68) pmol/L; p = 0.088] in the vitamin B12 group compared with the placebo group. The changes of serum vitamin B12 [54 (74) vs. 3 (60) pmol/L, p < 0.001], holoTC [21 (34) vs. 2 (32) pmol/L, p = 0.007], and tHcy [- 0.9 (2.3) vs. 0.3 (1.9) µmol/L, p = 0.010] were significantly different between the intervention groups. Mean percentage increase of serum vitamin B12 (+ 23% corresponds to + 54 pmol/L) in the vitamin B12 toothpaste group suggests that the intervention had provided an additional daily intake of approximately + 7 µg oral B12. Common diseases and drugs did not predict the change of blood markers in the vitamin group. No side effects were observed. CONCLUSIONS The toothpaste enriched with 100 µg cyanocobalamin/g has increased vitamin B12 status and can thus be used for preventing vitamin B12 depletion in elderly people. The trial was registered at ClinicalTrials.gov: NCT02679833.
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Del Bo' C, Riso P, Gardana C, Brusamolino A, Battezzati A, Ciappellano S. Effect of two different sublingual dosages of vitamin B 12 on cobalamin nutritional status in vegans and vegetarians with a marginal deficiency: A randomized controlled trial. Clin Nutr 2018; 38:575-583. [PMID: 29499976 DOI: 10.1016/j.clnu.2018.02.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 01/31/2018] [Accepted: 02/08/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Vegetarians and vegans are more vulnerable to vitamin B12 deficiency with severe risks of megaloblastic anemia, cognitive decline, neuropathy, and depression. An easy and simple method of supplementation consists of taking one weekly dosage of 2000 μg. However, single large oral doses of vitamin B12 are poorly absorbed. The present research evaluates the ability of two different sublingual dosages of vitamin B12 (350 μg/week vs 2000 μg/week) in improving cyanocobalamin (vitamin B12) nutritional status in vegans and vegetarians with a marginal deficiency. METHODS A 12-week randomized, double-blind, controlled, parallel intervention trial was performed. Forty subjects with marginal vitamin B12 deficiency were enrolled and randomly divided into two groups: test group Ld (low dose, 350 μg/week) and control group Hd (high dose, 2000 μg/week) vitamin B12 supplementation. Blood samples were collected at baseline and after 15, 30, 60, and 90 days from the intervention for the determination of vitamin B12, related metabolic markers, and blood cell counts. RESULTS Two-way analysis of variance showed a significant effect of time (P < 0.0001) and of time × treatment interaction (P = 0.012) on serum concentration of vitamin B12 that increased after 90-day supplementation (Ld and Hd) compared to baseline. Both the supplements increased (P < 0.0001, time effect) the levels of holotranscobalamin, succinic acid, methionine and wellness parameter, while decreased (P < 0.0001, time effect) the levels of methylmalonic acid, homocysteine and folate compared to baseline. No difference was observed between groups (Ld vs Hd). No effect was detected for vitamin B6 and blood cell count. CONCLUSIONS In our experimental conditions, both supplements were able to restore adequate serum concentrations of vitamin B12 and to improve the levels of related metabolic blood markers in subjects with a marginal deficiency. The results support the use of a sublingual dosage of 50 μg/day (350 μg/week) of cobalamin, instead of 2000 μg/week (provided as a single dose), to reach a state of nutritional adequacy of vitamin B12 in this target population. This study was registered at www.isrctn.org as ISRCTN75099618.
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Affiliation(s)
- Cristian Del Bo'
- Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Università degli Studi di Milano, Milan, Italy.
| | - Patrizia Riso
- Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Università degli Studi di Milano, Milan, Italy
| | - Claudio Gardana
- Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Università degli Studi di Milano, Milan, Italy
| | - Antonella Brusamolino
- Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Università degli Studi di Milano, Milan, Italy
| | - Alberto Battezzati
- Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Università degli Studi di Milano, Milan, Italy
| | - Salvatore Ciappellano
- Department of Food, Environmental and Nutritional Sciences, Division of Human Nutrition, Università degli Studi di Milano, Milan, Italy
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Green R, Allen LH, Bjørke-Monsen AL, Brito A, Guéant JL, Miller JW, Molloy AM, Nexo E, Stabler S, Toh BH, Ueland PM, Yajnik C. Vitamin B 12 deficiency. Nat Rev Dis Primers 2017; 3:17040. [PMID: 28660890 DOI: 10.1038/nrdp.2017.40] [Citation(s) in RCA: 465] [Impact Index Per Article: 66.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Vitamin B12 (B12; also known as cobalamin) is a B vitamin that has an important role in cellular metabolism, especially in DNA synthesis, methylation and mitochondrial metabolism. Clinical B12 deficiency with classic haematological and neurological manifestations is relatively uncommon. However, subclinical deficiency affects between 2.5% and 26% of the general population depending on the definition used, although the clinical relevance is unclear. B12 deficiency can affect individuals at all ages, but most particularly elderly individuals. Infants, children, adolescents and women of reproductive age are also at high risk of deficiency in populations where dietary intake of B12-containing animal-derived foods is restricted. Deficiency is caused by either inadequate intake, inadequate bioavailability or malabsorption. Disruption of B12 transport in the blood, or impaired cellular uptake or metabolism causes an intracellular deficiency. Diagnostic biomarkers for B12 status include decreased levels of circulating total B12 and transcobalamin-bound B12, and abnormally increased levels of homocysteine and methylmalonic acid. However, the exact cut-offs to classify clinical and subclinical deficiency remain debated. Management depends on B12 supplementation, either via high-dose oral routes or via parenteral administration. This Primer describes the current knowledge surrounding B12 deficiency, and highlights improvements in diagnostic methods as well as shifting concepts about the prevalence, causes and manifestations of B12 deficiency.
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Affiliation(s)
- Ralph Green
- Department of Pathology and Laboratory Medicine, University of California Davis, 4400 V Street, PATH Building, Davis, California 95817, USA
| | - Lindsay H Allen
- USDA, ARS Western Human Nutrition Research Center, University of California Davis, Davis, California, USA
| | | | - Alex Brito
- USDA, ARS Western Human Nutrition Research Center, University of California Davis, Davis, California, USA
| | - Jean-Louis Guéant
- Inserm UMRS 954 N-GERE (Nutrition Génétique et Exposition aux Risques Environnementaux), University of Lorraine and INSERM, Nancy, France
| | - Joshua W Miller
- School of Environmental and Biological Sciences, Rutgers University, New Brunswick, New Jersey, USA
| | - Anne M Molloy
- School of Medicine and School of Biochemistry and Immunology, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - Ebba Nexo
- Department of Clinical Medicine, Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Sally Stabler
- Department of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Ban-Hock Toh
- Centre for Inflammatory Diseases, Monash Institute of Medical Research, Clayton, Victoria, Australia
| | - Per Magne Ueland
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.,Section for Pharmacology, Department of Clinical Science, University of Bergen, Bergen, Norway
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Li P, Gu Q, Wang Y, Yu Y, Yang L, Chen JV. Novel vitamin B 12-producing Enterococcus spp. and preliminary in vitro evaluation of probiotic potentials. Appl Microbiol Biotechnol 2017. [PMID: 28634850 DOI: 10.1007/s00253-017-8373-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Vitamin B12 is an essential nutrient required for crucial metabolic processes in humans. Vitamin B12-producing lactic acid bacteria (LAB) have been attracting increased attentions currently because of the generally recognized as safe (GRAS) status. Most of recent studies focused on Lactobacillus, and little is known about B12-producing Enterococcus. In the present study, five Enterococcus strains isolated from infant feces were identified as vitamin B12 producers. Among them, Enterococcus faecium LZ86 had the highest B12 production (499.8 ± 83.7 μg/L), and the B12 compound from LZ86 was identified as the biological active adenosylcobalamin, using reversed phase high-performance liquid (RP-HPLC) chromatogram. We examined basic probiotic and safety properties of E. faecium LZ86 and found that it was able to survive harsh environmental conditions (hot temperature, cold temperature, ethanol and osmotic stresses), tolerate gastric acid (pH 2.0, 3 h) and bile salts (0.3%), and adhere to Caco-2 cells. We also showed that E. faecium LZ86 is devoid of transferable antibiotic resistance and potential virulence factors. Together, here we report a B12-producing E. faecium strain LZ86 firstly, which has desirable probiotic properties and may serve as a good candidate for vitamin B12 fortification in food industry.
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Affiliation(s)
- Ping Li
- Key Laboratory for Food Microbial Technology of Zhejiang Province, Zhejiang Gongshang University, Hangzhou, 310018, China
| | - Qing Gu
- Key Laboratory for Food Microbial Technology of Zhejiang Province, Zhejiang Gongshang University, Hangzhou, 310018, China.
| | - Yuejiao Wang
- Key Laboratory for Food Microbial Technology of Zhejiang Province, Zhejiang Gongshang University, Hangzhou, 310018, China
| | - Yue Yu
- Key Laboratory for Food Microbial Technology of Zhejiang Province, Zhejiang Gongshang University, Hangzhou, 310018, China
| | - Lanlan Yang
- Key Laboratory for Food Microbial Technology of Zhejiang Province, Zhejiang Gongshang University, Hangzhou, 310018, China
| | - Jieyan V Chen
- Neuroscience Research Institute, University of California, Santa Barbara, CA, 93106, USA
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Tillemans MPH, Donders EMVJ, Verweij SL, Van der Hoeven RTM, Kalisvaart KJ. Effect of administration route on the pharmacokinetics of cobalamin in elderly patients: a randomized controlled trial. Curr Ther Res Clin Exp 2014; 76:21-5. [PMID: 25031664 PMCID: PMC3994916 DOI: 10.1016/j.curtheres.2014.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND The gold standard for cobalamin deficiency treatment is administration of cobalamin by intramuscular injection. The injection is painful and inconvenient, particularly for elderly persons. Cobalamin might also be administered intranasally. Previous studies do not provide insight into the pharmacokinetics of intranasal cobalamin administration in comparison with cobalamin injection. AIM To quantify the pharmacokinetics of intranasally and intramuscularly administered cobalamin to determine if intranasal administration might be an alternative for intramuscular administration. METHODS Ten inpatients and outpatients of a geriatrics unit were recruited and randomly assigned to receive a single dose of 1000 μg cobalamin administered either by intranasal spray or intramuscular injection (5 per group). Inclusion criteria were written informed consent, age >65 years, and a cobalamin serum concentration <200 pmol/L. Total cobalamin serum concentrations were determined 10 times within 48 hours after administration. The differences in Cmax, Tmax, and AUC0-48 h per administration route were statistically compared using ANOVA. RESULTS The average Cmax was 1 nmol/L after intranasal and 38.5 nmol/L after intramuscular administration. The average Tmax for intranasal and intramuscular administration was 42 minutes versus 342 minutes, respectively, and the AUC0-48 h was 1.3 µmol/L/min versus 45.4 µmol/L/min, respectively. These values also differed significantly (P<0.05). The estimated bioavailability of the intranasal administration was 2%. CONCLUSIONS The pharmacokinetics of intranasal and intramuscular cobalamin administration in elderly, cobalamin-deficient patients differ significantly. However, the estimated 2% bioavailability of cobalamin after intranasal administration makes intranasal cobalamin administration a potentially interesting administration route for elderly patients. Netherlands Trial Registry identifier: NTR 3005.
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Affiliation(s)
| | - Eline M V J Donders
- Department of Geriatric Medicine, Kennemer Gasthuis, Haarlem, The Netherlands
| | - Sjoerd L Verweij
- Stichting Apotheek der Haarlemse Ziekenhuizen, Haarlem, The Netherlands
| | | | - Kees J Kalisvaart
- Department of Geriatric Medicine, Kennemer Gasthuis, Haarlem, The Netherlands
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Watanabe F, Yabuta Y, Tanioka Y, Bito T. Biologically active vitamin B12 compounds in foods for preventing deficiency among vegetarians and elderly subjects. JOURNAL OF AGRICULTURAL AND FOOD CHEMISTRY 2013; 61:6769-6775. [PMID: 23782218 DOI: 10.1021/jf401545z] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The usual dietary sources of vitamin B12 are animal-source based foods, including meat, milk, eggs, fish, and shellfish, although a few plant-based foods such as certain types of dried lavers (nori) and mushrooms contain substantial and considerable amounts of vitamin B12, respectively. Unexpectedly, detailed characterization of vitamin B12 compounds in foods reveals the presence of various corrinoids that are inactive in humans. The majority of edible blue-green algae (cyanobacteria) and certain edible shellfish predominately contain an inactive corrinoid known as pseudovitamin B12. Various factors affect the bioactivity of vitamin B12 in foods. For example, vitamin B12 is partially degraded and loses its biological activity during cooking and storage of foods. The intrinsic factor-mediated gastrointestinal absorption system in humans has evolved to selectively absorb active vitamin B12 from naturally occurring vitamin B12 compounds, including its degradation products and inactive corrinoids that are present in daily meal foods. The objective of this review is to present up-to-date information on various factors that can affect the bioactivity of vitamin B12 in foods. To prevent vitamin B12 deficiency in high-risk populations such as vegetarians and elderly subjects, it is necessary to identify plant-source foods that contain high levels of bioactive vitamin B12 and, in conjunction, to prepare the use of crystalline vitamin B12-fortified foods.
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Affiliation(s)
- Fumio Watanabe
- Division of Applied Bioresources Chemistry, The United Graduate School of Agricultural Sciences, Tottori University, Tottori 680-8553, Japan.
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Hill MH, Flatley JE, Barker ME, Garner CM, Manning NJ, Olpin SE, Moat SJ, Russell J, Powers HJ. A vitamin B-12 supplement of 500 μg/d for eight weeks does not normalize urinary methylmalonic acid or other biomarkers of vitamin B-12 status in elderly people with moderately poor vitamin B-12 status. J Nutr 2013; 143:142-7. [PMID: 23236022 DOI: 10.3945/jn.112.169193] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Plasma vitamin B-12 is the most commonly used biomarker of vitamin B-12 status, but the predictive value for low vitamin B-12 status is poor. The urinary methylmalonic acid (uMMA) concentration has potential as a functional biomarker of vitamin B-12 status, but the response to supplemental vitamin B-12 is uncertain. A study was conducted to investigate the responsiveness of uMMA to supplemental vitamin B-12 in comparison with other biomarkers of vitamin B-12 status [plasma vitamin B-12, serum holotranscobalamin (holoTC), plasma MMA] in elderly people with moderately poor vitamin B-12 status. A double-blind, placebo-controlled, randomized 8-wk intervention study was carried out using vitamin B-12 supplements (500 μg/d, 100 μg/d, and 10 μg/d cyanocobalamin) in 100 elderly people with a combined plasma vitamin B-12 <250 pmol/L and uMMA ratio (μmol MMA/mmol creatinine) >1.5. All biomarkers had a dose response to supplemental vitamin B-12. Improvements in plasma vitamin B-12 and serum holoTC were achieved at cobalamin supplements of 10 μg/d, but even 500 μg/d for 8 wk did not normalize plasma vitamin B-12 in 8% and serum holoTC in 12% of people. The response in uMMA was comparable with plasma MMA; 15-25% of people still showed evidence of metabolic deficiency after 500 μg/d cobalamin for 8 wk. There was a differential response in urinary and plasma MMA according to smoking behavior; the response was enhanced in ex-smokers compared with never-smokers. uMMA offers an alternative marker of metabolic vitamin-B12 status, obviating the need for blood sampling.
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Affiliation(s)
- Marilyn H Hill
- Human Nutrition Unit, Department of Oncology, Faculty of Medicine, Dentistry and Health, University of Sheffield, Sheffield, UK
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Dullemeijer C, Souverein OW, Doets EL, van der Voet H, van Wijngaarden JP, de Boer WJ, Plada M, Dhonukshe-Rutten RAM, In 't Veld PH, Cavelaars AEJM, de Groot LCPGM, van 't Veer P. Systematic review with dose-response meta-analyses between vitamin B-12 intake and European Micronutrient Recommendations Aligned's prioritized biomarkers of vitamin B-12 including randomized controlled trials and observational studies in adults and elderly persons. Am J Clin Nutr 2013; 97:390-402. [PMID: 23269815 DOI: 10.3945/ajcn.112.033951] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Many randomized controlled trials (RCTs) and observational studies have provided information on the association between vitamin B-12 intake and biomarkers. The use of these data to estimate dose-response relations provides a useful means to summarize the body of evidence. OBJECTIVE We systematically reviewed studies that investigated vitamin B-12 intake and biomarkers of vitamin B-12 status and estimated dose-response relations with the use of a meta-analysis. DESIGN This systematic review included all RCTs, prospective cohort studies, nested case-control studies, and cross-sectional studies in healthy adult populations published through January 2010 that supplied or measured dietary vitamin B-12 intake and measured vitamin B-12 status as serum or plasma vitamin B-12, methylmalonic acid (MMA), or holotranscobalamin. We calculated an intake-status regression coefficient ( ) for each individual study and calculated the overall pooled and SE ( ) by using random-effects meta-analysis on a double-log scale. RESULTS The meta-analysis of observational studies showed a weaker slope of dose-response relations than the meta-analysis of RCTs. The pooled dose-response relation of all studies between vitamin B-12 intake and status indicated that a doubling of the vitamin B-12 intake increased vitamin B-12 concentrations by 11% (95% CI: 9.4%, 12.5%). This increase was larger for studies in elderly persons (13%) than in studies in adults (8%). The dose-response relation between vitamin B-12 intake and MMA concentrations indicated a decrease in MMA of 7% (95% CI: -10%, -4%) for every doubling of the vitamin B-12 intake. The assessment of risk of bias within individual studies and across studies indicated risk that was unlikely to seriously alter these results. CONCLUSION The obtained dose-response estimate between vitamin B-12 intake and status provides complementary evidence to underpin recommendations for a vitamin B-12 intake of populations.
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Affiliation(s)
- Carla Dullemeijer
- Division of Human Nutrition, Wageningen University and Research Centre, Wageningen, Netherlands.
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Dyck MJ, Schumacher JR. Evidence-Based Practices for the Prevention of Weight Loss in Nursing Home Residents. J Gerontol Nurs 2011; 37:22-33; quiz 34-5. [DOI: 10.3928/00989134-20110106-04] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 06/16/2010] [Indexed: 01/04/2023]
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Favrat B, Vaucher P, Herzig L, Burnand B, Ali G, Boulat O, Bischoff T, Verdon F. Oral vitamin B12 for patients suspected of subtle cobalamin deficiency: a multicentre pragmatic randomised controlled trial. BMC FAMILY PRACTICE 2011; 12:2. [PMID: 21232119 PMCID: PMC3033340 DOI: 10.1186/1471-2296-12-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 01/13/2011] [Indexed: 01/28/2023]
Abstract
Background Evidence regarding the effectiveness of oral vitamin B12 in patients with serum vitamin B12 levels between 125-200 pM/l is lacking. We compared the effectiveness of one-month oral vitamin B12 supplementation in patients with a subtle vitamin B12 deficiency to that of a placebo. Methods This multicentre (13 general practices, two nursing homes, and one primary care center in western Switzerland), parallel, randomised, controlled, closed-label, observer-blind trial included 50 patients with serum vitamin B12 levels between 125-200 pM/l who were randomized to receive either oral vitamin B12 (1000 μg daily, N = 26) or placebo (N = 24) for four weeks. The institution's pharmacist used simple randomisation to generate a table and allocate treatments. The primary outcome was the change in serum methylmalonic acid (MMA) levels after one month of treatment. Secondary outcomes were changes in total homocysteine and serum vitamin B12 levels. Blood samples were centralised for analysis and adherence to treatment was verified by an electronic device (MEMS; Aardex Europe, Switzerland). Trial registration: ISRCTN 22063938. Results Baseline characteristics and adherence to treatment were similar in both groups. After one month, one patient in the placebo group was lost to follow-up. Data were evaluated by intention-to-treat analysis. One month of vitamin B12 treatment (N = 26) lowered serum MMA levels by 0.13 μmol/l (95%CI 0.06-0.19) more than the change observed in the placebo group (N = 23). The number of patients needed to treat to detect a metabolic response in MMA after one month was 2.6 (95% CI 1.7-6.4). A significant change was observed for the B12 serum level, but not for the homocysteine level, hematocrit, or mean corpuscular volume. After three months without active treatment (at four months), significant differences in MMA levels were no longer detected. Conclusions Oral vitamin B12 treatment normalised the metabolic markers of vitamin B12 deficiency. However, a one-month daily treatment with1000 μg oral vitamin B12 was not sufficient to normalise the deficiency markers for four months, and treatment had no effect on haematological signs of B12 deficiency.
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Affiliation(s)
- Bernard Favrat
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Bugnon 44, CH-1011 Lausanne, Switzerland.
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Deshmukh US, Joglekar CV, Lubree HG, Ramdas LV, Bhat DS, Naik SS, Hardikar PS, Raut DA, Konde TB, Wills AK, Jackson AA, Refsum H, Nanivadekar AS, Fall CH, Yajnik CS. Effect of physiological doses of oral vitamin B12 on plasma homocysteine: a randomized, placebo-controlled, double-blind trial in India. Eur J Clin Nutr 2010; 64:495-502. [PMID: 20216560 PMCID: PMC2865445 DOI: 10.1038/ejcn.2010.15] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 12/27/2009] [Accepted: 01/11/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVES Vitamin B(12) (B(12)) deficiency is common in Indians and a major contributor to hyperhomocysteinemia, which may influence fetal growth, risk of type II diabetes and cardiovascular disease. The purpose of this paper was to study the effect of physiological doses of B(12) and folic acid on plasma total homocysteine (tHcy) concentration. SUBJECTS/METHODS A cluster randomized, placebo-controlled, double-blind, 2 x 3 factorial trial, using the family as the randomization unit. B(12) was given as 2 or 10 microg capsules, with or without 200 microg folic acid, forming six groups (B(0)F(0), B(2)F(0), B(10)F(0), B(0)F(200), B(2)F(200) and B(10)F(200)). Plasma tHcy concentration was measured before and after 4 and 12 months of supplementation. RESULTS From 119 families in the Pune Maternal Nutrition Study, 300 individuals were randomized. There was no interaction between B(12) and folic acid (P=0.14) in relation to tHcy concentration change and their effects were analyzed separately: B(0) vs. B(2) vs. B(10); and F(0) vs. F(200). At 12 months, tHcy concentration reduced by a mean 5.9 (95% CI: -7.8, -4.1) micromol/l in B(2), and by 7.1 (95% CI: -8.9, -5.4) micromol/l in B(10), compared to nonsignificant rise of 1.2 (95% CI: -0.5, 2.9) micromol/l in B(0). B(2) and B(10) did not differ significantly. In F(200), tHcy concentration decreased by 4.8 (95% CI: -6.3, -3.3) micromol/l compared to 2.8 (95% CI: -4.3, -1.2) micromol/l in F(0). CONCLUSION Daily oral supplementation with physiological doses of B(12) is an effective community intervention to reduce tHcy. Folic acid (200 microg per day) showed no additional benefit, neither had any unfavorable effects.
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Affiliation(s)
- Urmila S Deshmukh
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, MS, India Fax: + 91 20 26111958
| | - Charudatta V Joglekar
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, MS, India Fax: + 91 20 26111958
| | - Himangi G Lubree
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, MS, India Fax: + 91 20 26111958
| | - Lalita V Ramdas
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, MS, India Fax: + 91 20 26111958
| | - Dattatray S Bhat
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, MS, India Fax: + 91 20 26111958
| | - Sadanand S Naik
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, MS, India Fax: + 91 20 26111958
| | - Pallavi S Hardikar
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, MS, India Fax: + 91 20 26111958
| | - Deepa A Raut
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, MS, India Fax: + 91 20 26111958
| | - Trupti B Konde
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, MS, India Fax: + 91 20 26111958
| | - Andrew K Wills
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK. Fax: + 44 23 80 704021
| | - Alan A Jackson
- Institute of Human Nutrition, University of Southampton, Southampton General Hospital, Southampton, UK. Fax: + 44 23 80 794 945
| | - Helga Refsum
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK and Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway. Fax: + 47 22 856 642
| | - Arun S Nanivadekar
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, MS, India Fax: + 91 20 26111958
| | - Caroline H Fall
- MRC Epidemiology Resource Centre, University of Southampton, Southampton General Hospital, Southampton, UK. Fax: + 44 23 80 704021
| | - Chittaranjan S Yajnik
- Diabetes Unit, King Edward Memorial Hospital Research Centre, Pune, MS, India Fax: + 91 20 26111958
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Hoey L, Strain JJ, McNulty H. Studies of biomarker responses to intervention with vitamin B-12: a systematic review of randomized controlled trials. Am J Clin Nutr 2009; 89:1981S-1996S. [PMID: 19403638 DOI: 10.3945/ajcn.2009.27230c] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Mild vitamin B-12 deficiency is common among older adults, but evidence for setting dietary recommendations is limited because most studies have administered vitamin B-12 via nonoral routes or at doses several hundred times higher than current recommendations. Furthermore, different biomarkers of vitamin B-12 status have not been systematically reviewed. OBJECTIVE The aim was to assess the effectiveness of biomarkers of vitamin B-12 status through a systematic review of published randomized controlled trials of oral vitamin B-12 supplementation. DESIGN Methods included a structured search strategy on Ovid MEDLINE, EMBASE (Ovid), and Cochrane databases; formal inclusion and exclusion criteria; data extraction; validity assessment; and meta-analysis. RESULTS Eight randomized controlled trials were included, and all studies measured serum and plasma total vitamin B-12, 3 studies measured methylmalonic acid, and 6 studies measured total homocysteine response. All 3 biomarkers were found to be effective measures of altered vitamin B-12 intake in populations with low and borderline baseline vitamin B-12 status (P < 0.00001); however, in the case of total vitamin B-12, substantial heterogeneity that could not be fully explained by subgroup analysis was observed. Insufficient data were available to determine the effectiveness of plasma holotranscobalamin, which was measured in only one randomized controlled trial. CONCLUSIONS The available evidence suggests that plasma and serum concentrations of total vitamin B-12, methylmalonic acid, and total homocysteine are all effective biomarkers of a change in vitamin B-12 intake; however, because the available data were limited, it was not possible to examine fully the factors that could explain the substantial heterogeneity in total vitamin B-12. Future trials should include low-dose vitamin B-12 in adults across the entire age spectrum and measure the holotranscobalamin response to supplementation.
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Affiliation(s)
- Leane Hoey
- Northern Ireland Centre for Food and Health, School of Biomedical Sciences, University of Ulster, Coleraine, Northern Ireland, United Kingdom.
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German JB, Gibson RA, Krauss RM, Nestel P, Lamarche B, van Staveren WA, Steijns JM, de Groot LCPGM, Lock AL, Destaillats F. A reappraisal of the impact of dairy foods and milk fat on cardiovascular disease risk. Eur J Nutr 2009; 48:191-203. [PMID: 19259609 PMCID: PMC2695872 DOI: 10.1007/s00394-009-0002-5] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2008] [Accepted: 01/26/2009] [Indexed: 02/07/2023]
Abstract
Background This review provides a reappraisal of the potential effects of dairy foods, including dairy fats, on cardiovascular disease (CVD)/coronary heart disease (CHD) risk. Commodities and foods containing saturated fats are of particular focus as current public dietary recommendations are directed toward reducing the intake of saturated fats as a means to improve the overall health of the population. A conference of scientists from different perspectives of dietary fat and health was convened in order to consider the scientific basis for these recommendations. Aims This review and summary of the conference focus on four key areas related to the biology of dairy foods and fats and their potential impact on human health: (a) the effect of dairy foods on CVD in prospective cohort studies; (b) the impact of dairy fat on plasma lipid risk factors for CVD; (c) the effects of dairy fat on non-lipid risk factors for CVD; and (d) the role of dairy products as essential contributors of micronutrients in reference food patterns for the elderly. Conclusions Despite the contribution of dairy products to the saturated fatty acid composition of the diet, and given the diversity of dairy foods of widely differing composition, there is no clear evidence that dairy food consumption is consistently associated with a higher risk of CVD. Thus, recommendations to reduce dairy food consumption irrespective of the nature of the dairy product should be made with caution.
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Affiliation(s)
- J Bruce German
- Department of Food Science and Technology, University of California, Davis, CA, 95616, USA.
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van Staveren WA, Steijns JM, de Groot LC. Dairy Products as Essential Contributors of (Micro-) Nutrients in Reference Food Patterns: An Outline for Elderly People. J Am Coll Nutr 2008; 27:747S-54S. [DOI: 10.1080/07315724.2008.10719753] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Ramel A, Jonsson PV, Bjornsson S, Thorsdottir I. Total Plasma Homocysteine in Hospitalized Elderly: Associations with Vitamin Status and Renal Function. ANNALS OF NUTRITION AND METABOLISM 2007; 51:527-32. [DOI: 10.1159/000112734] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Accepted: 07/05/2007] [Indexed: 11/19/2022]
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Dunne JL, Dahl WJ. A novel solution is needed to correct low nutrient intakes in elderly long-term care residents. Nutr Rev 2007; 65:135-8. [PMID: 17425065 DOI: 10.1111/j.1753-4887.2007.tb00291.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Currently, there is no consensus about how to best treat malnutrition in elderly long-term care residents. A recent study found that the traditional treatment method of serving small, frequent meals was not effective at increasing energy intake. This review describes strategies to treat malnutrition in this vulnerable population.
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Affiliation(s)
- Jennifer L Dunne
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada
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