Effect of vitamin B12 treatment on haptocorrin.

• Morkbak AL,
• Hvas AM,
• Lloyd-Wright Z,
• Sanders TA,
• Bleie O,
• Refsum H,
• Nygaard OK,
• Nexo E.

Department of Clinical Biochemistry, Aarhus Sygehus, Denmark. almor@as.aaa.dk

BACKGROUND: Haptocorrin (HC) carries the major part of circulating cobalamin, but whether HC is altered on treatment with vitamin B12 remains unknown. METHODS: Our study included 3 populations: a population of vegan men (n = 174; vegan population), of whom 63 were treated daily with 5 mg of oral vitamin B12 for 3 months; a group of patients with a previous methylmalonic acid (MMA) concentration >0.4 micromol/L (n = 140; population with suspected deficiency), of which 69 were treated with weekly vitamin B12 injections (1 mg) for 4 weeks; and a subgroup of participants in a vitamin B intervention study (n = 88; nondeficient population), of whom 45 were treated daily with 0.4 mg of oral vitamin B12 for 3 months. Total HC and holoHC were measured by ELISA. Cobalamin was measured by an intrinsic factor (IF)-based assay. Samples were collected at baseline and 3 months after start of treatment. RESULTS: Compared with baseline results for the 3 study populations, total HC and holoHC increased 30 pmol/L for every 100 pmol/L increase in cobalamin. After treatment with vitamin B12, holoHC (P <0.0001) and total HC (P <0.0001) increased significantly in the vegan population. Only holoHC increased in the population with suspected deficiency (P <0.0001), whereas no alteration was observed in the nondeficient population. CONCLUSIONS: The HC concentration is decreased in severely cobalamin-deficient individuals and increases on treatment. The concentration of cobalamin also relates significantly to the HC concentration in nondeficient individuals.

PMID: 16613998 [PubMed - indexed for MEDLINE]

Vitamin B12 deficiency in infancy as a cause of developmental regression.

• Casella EB,
• Valente M,
• de Navarro JM,
• Kok F.

Child Neurology Unit, Pediatric Department, University of Sao Paulo Medical School, Sao Paulo, Brazil. erasmobc@icr.hcnet.usp.br

Vitamin B12 deficiency can cause serious developmental regression, hypotonia and cerebral atrophy in infants. We report a 6-month-old infant, with insidious developmental regression and brain atrophy showed by CT scan, secondarily to vitamin B12 deficiency. His mother was a strict vegetarian and the patient was exclusively breastfed. The clinical symptoms and the brain CT were normalized after vitamin B12 administration.

PMID: 16310594 [PubMed - indexed for MEDLINE]

German vegan study: diet, life-style factors, and cardiovascular risk profile.

• Waldmann A,
• Koschizke JW,
• Leitzmann C,
• Hahn A.

Institute of Food Science, Centre Applied Chemistry, University of Hannover, Germany.

BACKGROUND/AIM: Evaluation of cardiovascular risk profile in 154 German vegans. METHODS: Cross-sectional study, Germany. Study instruments: 2 FFQ, 2 questionnaires, analyses of fasting venous blood samples. RESULTS: The total study population had a low BMI (mean: 22.3 kg/m(2)), a moderate blood pressure (mean: 120/75 mm Hg), an extremely low consumption of alcohol (mean: 0.77 g/day) and 96.8% were nonsmokers. Moderate physical activity (PAL) was reported by nearly 50%, whereas 22.7% declared to have a high PAL (>3 h/week). Median triacylglycerol (TG) was 0.81 mmol/l, total cholesterol (TC) was 4.33 mmol/l, HDL was 1.34 mmol/l. The mean TC/HDL-ratio was 3.3. Lipoprotein(a) (Lp(a)) was 8.13 mg/dl, concentrations of >30 mg/dl were prevalent in 25% of the participants. In general, status of folate and pyridoxine were sufficient, while 49.7% showed cobalamin concentrations <150 pmol/l. Plasma homocysteine levels were slightly elevated (median: 12.5 micromol/l). Cobalamin concentration and duration of vegan nutrition were the main determinants of homocysteine in the total study population. CONCLUSION: Although TC and LDL concentrations were favorable, low HDL and elevated homocysteine and Lp(a) concentrations were unfavorable. Overall, these results confirm the notion that a vegan diet is deficient in vitamin B(12), which may have an unfavorable effect on CHD risk.

PMID: 16219987 [PubMed - indexed for MEDLINE]

Long-term consumption of a raw food diet is associated with favorable serum LDL cholesterol and triglycerides but also with elevated plasma homocysteine and low serum HDL cholesterol in humans.

• Koebnick C,
• Garcia AL,
• Dagnelie PC,
• Strassner C,
• Lindemans J,
• Katz N,
• Leitzmann C,
• Hoffmann I.

Dietary Fibre and the Metabolic Syndrome Group, German Institute of Human Nutrition, Potsdam-Rehbruecke, D-14558 Nuthetal, Germany. koebnick@mail.dife.de

High consumption of vegetables and fruits is associated with reduced risk for cardiovascular disease. However, little information is available about diets based predominantly on consumption of fruits and their health consequences. We investigated the effects of an extremely high dietary intake of raw vegetables and fruits (70-100% raw food) on serum lipids and plasma vitamin B-12, folate, and total homocysteine (tHcy). In a cross-sectional study, the lipid, folate, vitamin B-12, and tHcy status of 201 adherents to a raw food diet (94 men and 107 women) were examined. The participants consumed approximately 1500-1800 g raw food of plant origin/d mainly as vegetables or fruits. Of the participants, 14% had high serum LDL cholesterol concentrations, 46% had low serum HDL cholesterol, and none had high triglycerides. Of raw food consumers, 38% were vitamin B-12 deficient, whereas 12% had an increased mean corpuscular volume (MCV). Plasma tHcy concentrations were correlated with plasma vitamin B-12 concentrations (r = -0.450, P < 0.001), but not with plasma folate. Plasma tHcy and MCV concentrations were higher in those in the lowest quintile of consumption of food of animal origin (P(trend) < 0.001). This study indicates that consumption of a strict raw food diet lowers plasma total cholesterol and triglyceride concentrations, but also lowers serum HDL cholesterol and increases tHcy concentrations due to vitamin B-12 deficiency.

PMID: 16177198 [PubMed - indexed for MEDLINE]

Low bone mineral density and bone mineral content are associated with low cobalamin status in adolescents.

• Dhonukshe-Rutten RA,
• van Dusseldorp M,
• Schneede J,
• de Groot LC,
• van Staveren WA.

Division of Human Nutrition, Wageningen University, 8129, 6700 EV, Wageningen, The Netherlands. rosalie.rutten@wur.nl

BACKGROUND: Cobalamin deficiency is prevalent in vegetarians and has been associated with increased risk of osteoporosis. AIM OF THE STUDY: To examine the association between cobalamin status and bone mineral density in adolescents formerly fed a macrobiotic diet and in their counterparts. METHODS: In this cross-sectional study bone mineral density (BMD) and bone mineral content (BMC) were determined by DEXA in 73 adolescents (9-15 y) who were fed a macrobiotic diet up to the age of 6 years followed by a lacto-(-ovo-) vegetarian or omnivorous diet. Data from 94 adolescents having consumed an omnivorous diet throughout their lives were used as controls. Serum concentrations of cobalamin, methylmalonic acid (MMA) and homocysteine were measured and calcium intake was assessed by questionnaire. Analysis of covariance (MANCOVA) was performed to calculate adjusted means for vitamin B12 and MMA for low and normal BMC and BMD groups. RESULTS: Serum cobalamin concentrations were significantly lower (geometric mean (GM) 246 pmol/L vs. 469 pmol/L) and MMA concentrations were significantly higher (GM 0.27 micromol/L vs. 0.16 micromol/L) in the formerly macrobiotic-fed adolescents compared to their counterparts. In the total study population, after adjusting for height, weight, bone area, percent lean body mass, age, puberty and calcium intake, serum MMA was significantly higher in subjects with a low BMD (p = 0.0003) than in subjects with a normal BMD. Vitamin B12 was significantly lower in the group with low BMD (p = 0.0035) or BMC (p = 0.0038) than in the group with normal BMD or BMC. When analyses were restricted to the group of formerly macrobiotic-fed adolescents, MMA concentration remained higher in the low BMD group compared to the normal BMD group. CONCLUSIONS: In adolescents, signs of an impaired cobalamin status, as judged by elevated concentrations of methylmalonic acid, were associated with low BMD. This was especially true in adolescents fed a macrobiotic diet during the first years of life, where cobalamin deficiency was more prominent.

PMID: 15338248 [PubMed - indexed for MEDLINE]

Spastic paraparesis as a manifestation of metabolic vitamin B12 deficiency: a case report.

• Cheng SH,
• Chang MH,
• Soong BW,
• Chen CW,
• Lee YC.

PMID: 15789129 [PubMed - indexed for MEDLINE]

Are you getting enough of this vitamin? If you're a vegetarian or over age 60, you need to be concerned about getting enough vitamin B12.

[No authors listed]

PMID: 16206385 [PubMed - indexed for MEDLINE]

Folate and cobalamin deficiencies and hyperhomocysteinemia in Bangladesh.

• Gamble MV,
• Ahsan H,
• Liu X,
• Factor-Litvak P,
• Ilievski V,
• Slavkovich V,
• Parvez F,
• Graziano JH.

Department of Environmental Health Sciences, School of Public Health, Columbia University, New York, NY 10032, USA. mvg7@columbia.edu

BACKGROUND: Indian Asian men residing in the United Kingdom have a higher prevalence of hyperhomocysteinemia than do their European counterparts. This has been largely attributed to dietary deficiencies in cobalamin associated with vegetarianism among these Indian Asians. OBJECTIVE: We aimed to ascertain the prevalence of folate and cobalamin deficiencies and hyperhomocysteinemia in Bangladesh. DESIGN: Plasma concentrations of homocysteine, folate, and cobalamin and urinary concentrations of creatinine were assessed in 1650 adults in Bangladesh. RESULTS: The prevalence of hyperhomocysteinemia (men: >11.4 micromol/L; women: >10.4 micromol/L) was markedly (P < 0.0001) greater among men (63%; x +/- SD: 15.3 +/- 9.5 micromol/L) than among women (26%; 9.5 +/- 4.7 micromol/L). Folate was lower (9.8 +/- 6.5 and 12.3 +/- 7.6 nmol/L, respectively), whereas cobalamin was higher (281 +/- 115 and 256 +/- 118 pmol/L, respectively) (P < 0.0001 for both) among men than among women. Folate explained 15% and cobalamin explained 5% of the variation in homocysteine concentrations. For men, folate (P = 0.005) and cobalamin (P = 0.03) were positively correlated with urinary creatinine. Smoking (P < 0.0003) and betelnut use (P < 0.0002) were independent negative predictors of folate. CONCLUSIONS: Bangladeshi men have a high prevalence of hyperhomocysteinemia, which is more closely associated with folate than with cobalamin, although other factors, eg, smoking and betelnut use, may also contribute to its cause. The positive correlations between urinary creatinine and plasma folate and cobalamin were unanticipated and could suggest that, in marginal nutrition, these vitamins may be limiting for creatine biosynthesis.

PMID: 15941889 [PubMed - indexed for MEDLINE]

Vitamin B12 deficiency presenting as oedema in infants of vegetarian mothers.

• Reghu A,
• Hosdurga S,
• Sandhu B,
• Spray C.

Department of Paediatric Gastroenterology, Bristol Royal Hospital for Children, Bristol, UK. anjana_kr@yahoo.co.uk

PMID: 15660229 [PubMed - indexed for MEDLINE]

Severe nutritional vitamin deficiency in a breast-fed infant of a vegan mother.

• Baatenburg de Jong R,
• Bekhof J,
• Roorda R,
• Zwart P.

Department of Paediatrics, Isala Klinieken, 8000 GM, Zwolle, The Netherlands. p.zwart@isala.nl

PMID: 15645284 [PubMed - indexed for MEDLINE]

Vitamin B12 deficiency in persons with intellectual disability in a vegetarian residential care community.

• Morad M,
• Gringols M,
• Kandel I,
• Merrick J.

Kfar Rafael Residential Care Center, Clalit Health Services and Division for Community Health, Ben Gurion University of the Negev, Beer-Sheva, Israel. morad@bgumail.bgu.ac.il

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.

PMID: 15674451 [PubMed - indexed for MEDLINE]

Long-term ovo-lacto vegetarian diet impairs vitamin B-12 status in pregnant women.

• Koebnick C,
• Hoffmann I,
• Dagnelie PC,
• Heins UA,
• Wickramasinghe SN,
• Ratnayaka ID,
• Gruendel S,
• Lindemans J,
• Leitzmann C.

German Institute of Human Nutrition Potsdam-Rehbrucke, Nuthetal, Germany. Koebnick@mail.dife.de

A well-planned vegetarian diet has been stated to be adequate during pregnancy. The aim of the present study was to compare serum vitamin B-12 and homocysteine concentrations in pregnant women (n = 109) consuming vegetarian and Western diets and to evaluate the adequacy of current dietary reference intakes of vitamin B-12 for these women. Pregnant women adhering to vegetarian diets for at least 3 y, with subgroups of ovo-lacto vegetarians (OLVs; n = 27), low-meat eaters (LME, n = 43), and women eating an average Western diet (control group, n = 39), were recruited. Dietary vitamin B-12 intake, serum vitamin B-12, and plasma total homocysteine (tHcy) concentrations were measured in wk 9-12, 20-22, and 36-38 of pregnancy. During pregnancy serum vitamin B-12 concentrations of ovo-lacto vegetarians (P < 0.001) and low-meat eaters (P = 0.050) were lower than those of the control group. We observed the combination of low serum vitamin B-12 concentrations and elevated plasma tHcy in 22% of ovo-lacto vegetarians, in 10% of low-meat eaters, and in 3% of controls (P = 0.003). In OLVs, serum vitamin B-12 predicted 60% of the plasma tHcy variation (P < 0.001), but in LMEs and controls only <10% (NS). Serum vitamin B-12 concentrations increased and plasma tHcy decreased sharply with increasing dietary intake of vitamin B-12 toward a cutoff point of 3 mug/d. Pregnant women consuming a long-term predominantly vegetarian diet have an increased risk of vitamin B-12 deficiency. Current recommended dietary intakes urgently need reevaluation.

PMID: 15570032 [PubMed - indexed for MEDLINE]

Use of fasting urinary methylmalonic acid to screen for metabolic vitamin B12 deficiency in older persons.

• Kwok T,
• Cheng G,
• Lai WK,
• Poon P,
• Woo J,
• Pang CP.

Department of Medicine and Therapeutics, Shatin, Hong Kong, Peoples' Republic of China. tkwok@cuhk.edu.hk

OBJECTIVES: We sought to determine the cutoffs of fasting urinary methylmalonic acid (MMA) indicating elevated and mildly elevated serum MMA concentrations in older persons. METHODS: We studied 113 female Chinese vegetarians older than 55 y with normal renal function. Fasting serum samples were obtained for measurement of vitamin B12, MMA, and folate and tests of renal function. A fasting urine sample was collected for MMA measurement by the stable-isotope dilution method. The correlation between serum and urinary MMA levels was examined. The optimal cutoffs of urinary MMA for predicting elevated and mildly elevated serum MMA were estimated by use of receiver operating characteristic curves. RESULTS: Fasting urinary and serum MMA levels were linearly correlated. Pearson's correlation coefficient was 0.94. The cutoff of fasting urinary MMA of 2 microM/mM of creatinine had a sensitivity of 79%, a specificity of 85%, and a positive predictive value of 93% for elevated serum MMA (> 0.4 microM/L). A cutoff of 1.5 microM/mM of creatinine had a sensitivity of 86%, a specificity of 85%, and a positive predictive value of 95% for mildly elevated serum MMA (> 0.3 microM/L). Both cutoffs had high positive predictive values for subnormal vitamin B12 concentrations. CONCLUSION: Overnight fasting urinary MMA concentrations have a strong linear relation to serum MMA in older vegetarians without renal impairment. Urinary MMA is potentially useful as a screening tool for metabolic vitamin B12 deficiency in older persons.

PMID: 15325684 [PubMed - indexed for MEDLINE]

Homocysteine and cobalamin status in German vegans.

• Waldmann A,
• Koschizke JW,
• Leitzmann C,
• Hahn A.

Institute of Food Science, University of Hanover, Wunstorfer Strasse 14, D-30453 Hanover, Germany.

OBJECTIVE: The study aimed to evaluate the homocysteine and cobalamin status of German vegans and determine whether the intake of very small amounts of foods of animal origin can improve this status. DESIGN AND SETTING: Cross-sectional study, Germany. SUBJECTS: The dietary and nutritional intakes of 131 vegans (73 women, 58 men; age range: 20.2-82.1 years) were evaluated using a general questionnaire and two food-frequency questionnaires. RESULTS: The prevalence of inadequate cobalamin status in volunteers of the German Vegan Study was 28.2%, and that of hyperhomocysteinaemia, 38.1%. Moderate vegans were affected to a lesser extent than were strict vegans. Duration of veganism and cobalamin concentration were inversely correlated (Spearman's r=-0.175, P=0.047). Folate concentration and erythrocyte aspartic acid aminotransferase activity were not correlated with plasma homocysteine concentration, but duration of veganism correlated positively with homocysteine concentration (Spearman's r=0.319, P<0.001). Cobalamin and homocysteine concentrations were inversely correlated (when controlling for duration of veganism; r=-0.602, P<0.001). CONCLUSION: Cobalamin status needs to be improved in order to minimise the risk of hyperhomocysteinaemia.

PMID: 15153278 [PubMed - indexed for MEDLINE]

Severe vitamin B12 deficiency in an infant associated with a maternal deficiency and a strict vegetarian diet.

• Weiss R,
• Fogelman Y,
• Bennett M.

Department of Family Medicine, Ha'Emek Medical Center, Afula, Israel.

The authors present a case of severe megaloblastic anemia and neurologic damage due to vitamin B12 deficiency in a 6-month-old infant. The cause of the vitamin deficiency was a maternal dietary deficiency because of a strict vegetarian diet and prolonged breast-feeding. The importance of early recognition of significant maternal vitamin B12 deficiency during pregnancy and lactation in vegetarians is emphasized so that appropriate supplementation can be given and irreversible neurologic damage in the infant prevented.

PMID: 15087959 [PubMed - indexed for MEDLINE]

[Vitamin B(12) deficiency anaemia in a 7.5 months old girl]

• Jarosz M,
• Irga N,
• Wierzba J.

Klinika Pediatrii, Hematologii, Onkologii i Endokrynologii, Akademia Medyczna, Debinki 7, 80-211 Gdansk, Poland. m.jarosz@amg.gda.pl

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. Gdansk 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 [PubMed - indexed for MEDLINE]

[Funicular myelosis]

• Heckmann JG,
• Weber M,
• Lang C,
• Strauss S,
• Tomandl B,
• Neundorfer B.

Neurologische Klinik der Universitat Erlangen-Nurnberg, Erlangen-Nurnberg, Germany. josef.heckmann@neuro.imed.uni-erlangen.de

PMID: 14716485 [PubMed - indexed for MEDLINE]

Vitamin B12 deficiency as a worldwide problem.

• Stabler SP,
• Allen RH.

Division of Hematology, Department of Medicine, University of Colorado Health Sciences Center, Denver, Colorado 80262, USA. Sally.Stabler@UCHSC.edu

Pernicious anemia is a common cause of megaloblastic anemia throughout the world and especially in persons of European or African descent. Dietary deficiency of vitamin B12 due to vegetarianism is increasing and causes hyperhomocysteinemia. The breast-fed infant of a vitamin B12-deficient mother is at risk for severe developmental abnormalities, growth failure, and anemia. Elevated methylmalonic acid and/or total homocysteine are sensitive indicators of vitamin B12-deficient diets and correlate with clinical abnormalities. Dietary vitamin B12 deficiency is a severe problem in the Indian subcontinent, Mexico, Central and South America, and selected areas in Africa. Dietary vitamin B12 deficiency is not prevalent in Asia, except in vegetarians. Areas for research include intermittent vitamin B12 supplement dosing and better measurements of the bioavailability of B12 in fermented vegetarian foods and algae.

PMID: 15189123 [PubMed - indexed for MEDLINE]

Comparison of the dietary cobalt intake in three different Australian diets.

• Hokin B,
• Adams M,
• Ashton J,
• Louie H.

School of Applied of Sciences, University of Newcastle, NSW, Australia. bevan@sah.org.au

Differences in the dietary intake of cobalt were assessed for vegans, lacto-ovo-vegetarian and non-vegetarian Australians using food intake logs, and daily or average trend recall over three months. A significant decrease in cobalt intake was observed for the lacto-ovo-vegetarian population compared with the intake in vegans and omnivores. There is no RDI for cobalt, however, the cobalt intake of Australians was similar to that reported in other countries. Microflora above the terminal ileum have been shown to produce significant amounts of biologically available vitamin B12. This study was unable to demonstrate a correlation between elemental cobalt intake and serum vitamin B12 concentrations in humans, as has been shown in vitro.

PMID: 15331342 [PubMed - indexed for MEDLINE]

Functional vitamin B12 deficiency and determination of holotranscobalamin in populations at risk.

• Herrmann W,
• Obeid R,
• Schorr H,
• Geisel J.

Department of Clinical Chemistry, School of Medicine, Saarland University, Homburg, Germany. kchwher@uniklinik-saarland.de

BACKGROUND: The prevalence of a sub-clinical functional vitamin B12 deficiency in the general population is higher than previously expected. Total serum vitamin B12 may not reliably indicate vitamin B12 status. To get more specificity and sensitivity in diagnosing vitamin B12 deficiency, the concept of measuring holotranscobalamin II (holoTC), a sub-fraction of vitamin B12, has aroused great interest. HoloTC as a biologically active vitamin B12 fraction promotes a specific uptake of its vitamin B12 by all cells. In this study we investigated the diagnostic value of storage (holoTC) of vitamin B12 and functional markers (methylmalonic acid (MMA)) of vitamin B12 metabolism in populations who are at risk of vitamin B12 deficiency. SUBJECTS AND METHODS: Our study included 93 omnivorous German controls, 111 German and Dutch vegetarian subjects, 122 Syrian apparently healthy subjects, 127 elderly Germans and finally 92 German pre-dialysis renal patients. Serum concentrations of homocysteine (Hcy) and MMA were measured by gas chromatography-mass spectrometry, folate and vitamin B12 by chemiluminescence immunoassay, and holoTC by utilizing a RIA test. RESULTS: High Hcy (>12 micromol/l), high MMA (>271 nmol/l) resp. low holoTC (vitamin B12) in serum were detected in 15%, 8% resp. 13% (1%) of German controls, 36%, 60%, resp. 72% (30%) of vegetarians, 42%, 48% resp. 50% (6%) of Syrians, 75%, 42%, resp. 21% (7%) of elderly subjects and 75%, 67% resp. 4% (2%) of renal patients. The lowest median levels of holoTC were observed in vegetarians, followed by the Syrian subjects (23 and 35 pmol/l, respectively). Renal patients had significantly higher levels of holoTC compared to the German controls (74 vs. 54 pmol/l). In the vitamin B12 range between 156 pmol/l (conventional cut-off level) and 241 pmol/l, both mean concentrations of holoTC and MMA were in the pathological range. HoloTC was the earliest marker for vitamin B12 deficiency followed by MMA. Vitamin B12 deficiency causes folate trapping. A higher folate level is required to keep Hcy normal. The relationship between MMA and holoTC seemed dependent on renal function. In renal patients with a glomerular filtration rate below 36 ml/min, a significantly lower mean level of MMA was detected within the highest tertile of holoTC concentration, compared to the lowest tertile. Thus, in renal patients, a higher serum concentration of circulating holoTC is required to deliver sufficient amounts of holoTC into the cells. CONCLUSION: Our data support the concept that the measurement of holoTC and MMA provides a better index of cobalamin status than the measurement of total vitamin B12. HoloTC is the most sensitive marker, followed by MMA. The use of holoTC and MMA enables us to differentiate between storage depletion and functional vitamin B12 deficiency. Renal patients have a higher requirement of circulating holoTC. In renal dysfunction, holoTC cannot be used as a marker of vitamin B12 status.

PMID: 14656029 [PubMed - indexed for MEDLINE]

[Nutrition and health--potential health benefits and risks of vegetarianism and limited consumption of meat in the Netherlands]

• Dagnelie PC.

Universiteit Maastricht, capaciteitsgroep Epidemiologie, Postbus 616, 6200 MD Maastricht. dagnelie@epid.unimaas.nl

In the latest Dutch national food consumption survey (1998) just over 1% of subjects (about 150,000 persons) claimed to be vegetarians; however, a much larger group (6% or approximately 1 million persons) ate meat < or = once a week. Vegetarianism can be subdivided into lacto-vegetarianism (a diet without meat and fish) and veganism (a diet without any animal foods whatsoever, including dairy products and eggs). A recent meta-analysis showed that vegetarians had a lower mortality from ischaemic heart disease than omniovorous subjects; however, cancer mortality and total mortality did not differ. Although a high consumption of red meat, which is rich in haeme iron and saturated fat, may increase the risk of cardiovascular disease and some types of cancer, this does not apply to white meat and fish. In fact, the most important protective effect would seem to be derived from the consumption of unrefined vegetable products (whole-grain cereals, vegetables, fruits, nuts and legumes) and fish. In other words, a prudent, omnivorous diet with moderate amounts of animal products, in which red meat is partly replaced by white meat and fish (especially fatty fish), together with the consumption of ample amounts of unrefined vegetable products, is thought to be just as protective as a vegetarian diet. On the other hand, the omission of meat and fish from the diet increases the risk of nutritional deficiencies. A vegan diet, in particular, leads to a strongly increased risk of deficiencies of vitamin B12, vitamin B2 and several minerals, such as calcium, iron and zinc. However, even a lacto-vegetarian diet produces an increased risk of deficiencies of vitamin B12 and possibly certain minerals, such as iron. Data from the latest Dutch food consumption survey suggest that 5-10% of all inhabitants of the Netherlands (up to 1 million persons) actually have a vitamin B12 intake below recommended daily levels. In medical practice, the possibility of vitamin B12 deficiency in subjects consuming meat or fish < or = once a week deserves serious consideration. In case of doubt, evaluation is indicated using sensitive and specific deficiency markers such as the levels of methylmalonic acid in plasma or urine. Alternative dietary sources of vitamin B12 instead of meat are fish (especially fatty fish is a good source of vitamin B12), or a vitamin-B12-supplement.

PMID: 12868158 [PubMed - indexed for MEDLINE]

Comment in:

Am J Clin Nutr. 2003 Jul;78(1):3-6.

Vitamin B-12 status, particularly holotranscobalamin II and methylmalonic acid concentrations, and hyperhomocysteinemia in vegetarians.

• Herrmann W,
• Schorr H,
• Obeid R,
• Geisel J.

Central Laboratory, Department of Clinical Chemistry, Saarland University Hospital, Homburg, Germany. kchwher@uniklinik-saarland.de

BACKGROUND: Vegetarians have a lower intake of vitamin B-12 than do omnivores. Early and reliable diagnosis of vitamin B-12 deficiency is very important. OBJECTIVE: The objective was to investigate vitamin B-12 status in vegetarians and nonvegetarians. DESIGN: The study cohort included 66 lactovegetarians or lactoovovegetarians (LV-LOV group), 29 vegans, and 79 omnivores. Total vitamin B-12, methylmalonic acid, holotranscobalamin II, and total homocysteine concentrations were assayed in serum. RESULTS: Of the 3 groups, the vegans had the lowest vitamin B-12 status. In subjects who did not consume vitamins, low holotranscobalamin II (< 35 pmol/L) was found in 11% of the omnivores, 77% of the LV-LOV group, and 92% of the vegans. Elevated methylmalonic acid (> 271 nmol/L) was found in 5% of the omnivores, 68% of the LV-LOV group, and 83% of the vegans. Hyperhomocysteinemia (> 12 micromol/L) was present in 16% of the omnivores, 38% of the LV-LOV group, and 67% of the vegans. The correlation between holotranscobalamin II and vitamin B-12 was weak in the low serum vitamin B-12 range (r = 0.403) and strong in the high serum vitamin B-12 range (r = 0.769). Holotranscobalamin II concentration was the main determinant of total homocysteine concentration in the vegetarians (beta = -0.237, P < 0.001). Vitamin B-12 deficiency led to hyperhomocysteinemia that was not probable in the upper folate range (> 42.0 nmol/L). CONCLUSIONS: Vegan subjects and, to a lesser degree, subjects in the LV-LOV group had metabolic features indicating vitamin B-12 deficiency that led to a substantial increase in total homocysteine concentrations. Vitamin B-12 status should be monitored in vegetarians. Health aspects of vegetarianism should be considered in the light of possible damaging effects arising from vitamin B-12 deficiency and hyperhomocysteinemia.

PMID: 12816782 [PubMed - indexed for MEDLINE]

Functional hyperhomocysteinemia in healthy vegetarians: no association with advanced glycation end products, markers of protein oxidation, or lipid peroxidation after correction with vitamin B(12).

• Sebekova K,
• Krajcovicova-Kudlackova M,
• Blazicek P,
• Parrak V,
• Schinzel R,
• Heidland A.

Institute of Preventive and Clinical Medicine, 833 01 Bratislava, Slovakia. sebekova@upkm.sk

PMID: 12766005 [PubMed - indexed for MEDLINE]

Comment in:

Eur J Obstet Gynecol Reprod Biol. 2004 Aug 10;115(2):240-1; author reply 241-2.

Eur J Obstet Gynecol Reprod Biol. 2004 Aug 10;115(2):241-2.

Serum folate and Vitamin B12 levels in women using modern oral contraceptives (OC) containing 20 microg ethinyl estradiol.

• Sutterlin MW,
• Bussen SS,
• Rieger L,
• Dietl J,
• Steck T.

Department of Obstetrics and Gynecology, University of Wurzburg, Josef-Schneider-Str 4, D-97080 Wurzburg, Germany.

OBJECTIVE: The effects of modern oral contraceptives (OC) on serum concentrations of folate and cobalamin are controversial. STUDY DESIGN: Case-control study on the cobalamin and folate status of 71 healthy female nulligravidae using "low dose" OC for >or=3 months and 170 controls. Factors interfering with vitamin metabolism were thoroughly controlled. Serum concentrations were measured by commercial assays. The results were evaluated using Mann-Whitney's U-test and chi(2) analysis. RESULTS: OC-users showed significantly lower concentrations of cobalamin than controls. The rates of women with reduced, normal, and elevated levels differed significantly. Nine users but no control had frank cobalamin deficiency without clinical symptoms. Folate levels did not differ between the groups. Vegetarian diet, smoking or obesity did not have a significant influence. CONCLUSIONS: Routine measurement of cobalamin or folate in women using "low dose" OC is not warranted. Vitamin supplementation or different contraceptive methods should be considered in women with pre-existing cobalamin deficiency or restrictive dietary habits.

PMID: 12593896 [PubMed - indexed for MEDLINE]

Vegetarian lifestyle and monitoring of vitamin B-12 status.

• Herrmann W,
• Geisel J.

Department of Clinical Chemistry-Central Laboratory, University Hospital of the Saarland, Bld. 40, D-66421 Homburg/Saar, Germany. kchwher@uniklinik-saarland.de

Vegetarians are at risk to develop deficiencies of some essential nutrients, especially vitamin B-12 (cobalamin). Cobalamin occurs in substantial amounts only in foods derived from animals and is essential for one-carbon metabolism and cell division. Low nutritional intake of vitamin B-12 may lead to negative balance and, finally, to functional deficiency when tissue stores of vitamin B-12 are depleted. Early diagnosis of vitamin B-12 deficiency seems to be useful because irreversible neurological damages may be prevented by cobalamin substitution.The search for a specific and sensitive test to diagnose vitamin B-12 deficiency is ongoing. Serum vitamin B-12 measurement is a widely applied standard method. However, the test has poor predictive value. Optimal monitoring of cobalamin status in vegetarians should include the measurement of homocysteine (HCY), methylmalonic acid (MMA), and holotranscobalamin II. Vitamin B-12 deficiency can be divided into four stages. In stages I and II, indicated by a low plasma level of holotranscobalamin II, the plasma and cell stores become depleted. Stage III is characterized by increased levels of HCY and MMA in addition to lowered holotranscobalamin II. In stage IV, clinical signs become recognizable like macroovalocytosis, elevated MCV of erythrocytes or lowered haemoglobin. In our investigations, we have found stage III of vitamin B-12 deficiency in over 60% of vegetarians, thus underlining the importance of cobalamin monitoring in this dietary group.

PMID: 12417096 [PubMed - indexed for MEDLINE]

[Therapy of hyperhomocysteinemia with vitamin B12]

• Krajcovicova-Kudlackova M,
• Blazicek P,
• Sebekova K,
• Valachovicova M.

kudlackova@upkm.sk

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 [PubMed - indexed for MEDLINE]

The impact of vegetarianism on some haematological parameters.

• Obeid R,
• Geisel J,
• Schorr H,
• Hubner U,
• Herrmann W.

Department of Clinical Chemistry, University Hospital of Saarland, Homburg, Germany.

OBJECTIVE: Subjects adopting a vegetarian diet are liable to vitamin B12 and iron deficiencies. Co-existing vitamin B12 and iron deficiencies may give an equivocal haematological picture, which may, in turn, delay making an early diagnosis. The current work was undertaken to investigate some haematological parameters in relation to vitamin B12 and iron status in vegetarians. SUBJECTS AND METHODS: Twenty-nine vegans, 64 lacto- and lacto-ovo-vegetarians, in addition to 20 occasional meat eaters, were enrolled for this study. The total group included 49 males and 64 females aged [mean (SD) = 46(15) yr]. Complete blood count, methylmalonic acid (MMA), homocysteine (HCY), ferritin, and transferrin concentrations and percentage transferrin saturation were assayed, using conventional methods. RESULTS: Vegans displayed the highest MMA and HCY levels (median MMA = 708 nmol L(-1); HCY = 12.8 micromol L(-1)). A lower lymphocyte count and a higher mean corpuscular volume (MCV) were found in vegans compared with lacto- or lacto-ovo-vegetarians (median = 1.51 x 10(9) vs. 1.83 x 10(9) L(-1); 92 vs. 89 fL, respectively). Vitamin B12-deficient subjects in the higher range of transferrin saturation percentage had higher MCV than vitamin B12-deficient subjects in the lower transferrin saturation range (mean MCV = 92 vs. 89 fL). A lower platelet count was found in the highest quartile of MMA (mean = 211 x 10(9) L(-1)) and in the highest quartile of HCY (mean = 215 x 10(9) L(-1)), compared with the other quartiles. Lower lymphocyte and platelet counts and higher MCV were found in subjects with elevated MMA and HCY, compared to those with normal metabolites. Factors that explained the variations in MCV were red blood cell count, ferritin, transferrin saturation, and methylmalonic acid levels. CONCLUSION: vitamin B12 and iron status were compromised by a vegetarian diet. Variations in mean corpuscular volume were determined by iron and vitamin B12 status. Lower lymphocyte and platelet count were accompanied by metabolic evidence that indicated vitamin B12 deficiency.

PMID: 12460231 [PubMed - indexed for MEDLINE]

Independent effect of vitamin B12 deficiency on hematological status in older Chinese vegetarian women.

• Kwok T,
• Cheng G,
• Woo J,
• Lai WK,
• Pang CP.

Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin. tkwok@cuhk.edu.hk

We have examined the independent effect of vitamin B(12) deficiency on hematological indices in older Chinese vegetarian women using a cross-sectional study design: 119 women older than 55 years who had been vegetarian for more than 3 years were studied. Fasting blood samples were taken for complete blood count, serum iron, total serum iron binding capacity, serum iron saturation, serum vitamin B(12), serum folate, serum methylmalonic acid levels (MMA), and renal function test. Subjects with iron deficiency (iron saturation <15%) and those with serum creatinine >150 mmol/L were excluded. The prevalence of definite vitamin B(12) deficiency (vitamin B(12) level < 150 pmol/L and MMA >or= 0.4 micromol/L) was 42%. Another 32.8% had possible vitamin B(12) deficiency (either criterion). The prevalence of iron deficiency was 10%. After exclusions, 96 subjects were further analyzed. Vitamin B(12) deficiency defined by serum vitamin B(12) and MMA was associated with a decrease in hemoglobin concentrations by up to 0.9 g/dL, but it was not associated with an increase in mean corpuscular volume (MCV). Serum MMA but not vitamin B(12) levels correlated inversely with hemoglobin and platelet counts and positively with MCV, after adjustment of confounding factors. However, the percentage of subjects with anemia did not increase significantly until serum MMA became >1.0 micromol/L. In conclusion, vitamin B(12) deficiency was associated with a significant decrease in hemoglobin concentration. However, anemia associated with vitamin B(12) deficiency was seldom macrocytic. We recommend that older vegetarians should be given vitamin B(12) supplements routinely. Copyright 2002 Wiley-Liss, Inc.

PMID: 12111763 [PubMed - indexed for MEDLINE]

Comment in:

Am J Hematol. 2003 Feb;72(2):151-2.

Hyperhomocysteinemia and cobalamin deficiency in young Asian Indians in the United States.

• Carmel R,
• Mallidi PV,
• Vinarskiy S,
• Brar S,
• Frouhar Z.

Department of Medicine, New York Methodist Hospital, 506 Sixth Street, Brooklyn, NY 11215, USA. rac9001@nyp.org

Hyperhomocysteinemia, a risk factor for vascular disease, may be a particular problem in Asian Indians, but information is limited, especially in the U.S., despite its growing Asian population. Moreover, suggestions have been made that folate deficiency is responsible for the hyperhomocysteinemia in Indians. Therefore, we studied homocysteine status in healthy Asian Indians in the U.S. prospectively, determined the frequency of cobalamin and folate deficiency as contributors to it, and examined whether food-cobalamin absorption contributed to cobalamin deficiency. Homocysteine levels were higher in Asian Indian men than in 4 other ethnic groups (P < 0.0001); 10/39 Indian men (25.6%) were hyperhomocysteinemic. Cobalamin levels were lower in Indian men (P = 0.000005) and women (P = 0.03) than in non-Indians; low levels were found more frequently in both Indian men (23/39; 59.0%) and women (5/21; 23.8%) than in others. Measuring methylmalonic acid in 10 selected subjects showed that the low cobalamin levels reflected cobalamin deficiency, and high methylmalonic acid levels were found in some subjects without hyperhomocysteinemia. Evidence of folate deficiency was not found in any subjects. Food-cobalamin absorption was normal in all 13 Indian subjects tested, including those with Helicobacter pylori infection. The results show that hyperhomocysteinemia is strikingly common in apparently healthy, young Asian Indian men. The cause appears to be cobalamin deficiency, which affected more than half of the Indian men, may be largely subclinical, is underestimated by homocysteine levels alone which were not always abnormal, and is probably largely dietary in origin. Folate deficiency is rare. This public health problem is amenable to prevention and treatment in this growing segment of the U.S. population. It was, parenthetically, noteworthy that many of the affected subjects were young physician trainees. Copyright 2002 Wiley-Liss, Inc.

PMID: 12111783 [PubMed - indexed for MEDLINE]

Comment in:

Dent Update. 2002 Dec;29(10):515.

Iron and vitamin B12 deficiency anaemia in a vegetarian: a diagnostic approach by enzyme-linked immunosorbent assay and radioimmunoassay.

• Iamaroon A,
• Linpisarn S,
• Kuansuwan C.

Department of Odontology and Oral Pathology, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.

This article presents the case of a 46-year-old vegetarian who had a painful dry socket in the left third molar areas. Since the patient's general appraisal was anaemic, investigations for haematological status, folic acid and vitamin B12 were performed. The results revealed that the patient was severely iron deficient and slightly vitamin B12 deficient.

PMID: 12096380 [PubMed - indexed for MEDLINE]

Dietary vitamin B12 deficiency in an adolescent white boy.

• O'Gorman P,
• Holmes D,
• Ramanan AV,
• Bose-Haider B,
• Lewis MJ,
• Will A.

Department of Paediatric Haematology, Royal Manchester Children's Hospital, M27 4HA, UK.

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 [PubMed - indexed for MEDLINE]

Plasma homocysteine levels in Taiwanese vegetarians are higher than those of omnivores.

• Hung CJ,
• Huang PC,
• Lu SC,
• Li YH,
• Huang HB,
• Lin BF,
• Chang SJ,
• Chou HF.

Department of Biochemistry, College of Medicine, Tzu-Chi University, Hualien, Taiwan.

Mild hyperhomocysteinemia is an independent risk factor for cardiovascular disease and may result from a deficiency of folate, vitamin B-6 or vitamin B-12. Because vitamin B-12 deficiency is often associated with vegetarianism, this study was designed to examine the effect of Taiwanese vegetarian diets on B-vitamin status and plasma homocysteine levels. Female Buddhist lacto-vegetarians (n = 45; 31-45 y) and matched omnivores (n = 45) recruited in Hualien, Taiwan, were investigated. Taiwanese vegetarians consumed normal amount of folate, but only 21% of Taiwan Recommended Daily Nutrient Allowances (RDNA) values of vitamin B-12. Compared with the omnivores, the vegetarians had significantly higher levels of plasma folate (14.79 +/- 7.70 vs. 11.98 +/- 8.29 nmol/L), but lower levels of vitamin B-12 (207.7 +/- 127.1 vs. 403.5 +/- 138.9 pmol/L). Fasting plasma homocysteine levels were significantly higher in vegetarians than in omnivores (mean: 11.20 +/- 4.27 vs. 8.64 +/- 2.06 micromol/L; median: 10.5 vs. 8.5 micromol/L). Fasting plasma homocysteine was inversely correlated with plasma folate and vitamin B-12 in the vegetarian group. Multiple regression analysis revealed that plasma folate, vitamin B-12 and creatinine were independent determinants of homocysteine variation and contributed to 38.6% of homocysteine variation in the vegetarians. Compared with the omnivores, vegetarians also had significantly lower serum levels of valine, isoleucine, leucine, lysine, alanine and arginine, but higher levels of glycine. In the vegetarian group, fasting plasma homocysteine correlated negatively with serum threonine, lysine, histidine, arginine and cystine, and these amino acids contributed to 38.7% of homocysteine variation. In conclusion, the Buddhist nuns who consumed a lacto-vegetarian diet had mildly elevated fasting plasma homocysteine levels presumably due to lower levels of plasma vitamin B-12.

PMID: 11823571 [PubMed - indexed for MEDLINE]

Impact of vitamin B-12 deficiency during lactation on maternal and infant health.

• Allen LH.

Department of Nutrition, University of California, Davis 95616, USA.

PMID: 12026028 [PubMed - indexed for MEDLINE]

[Subacute combined degeneration. A description of the case of a strictly vegetarian child]

• Cornejo W,
• Gonzalez F,
• Toro ME,
• Cabrera D.

Universidad de Antioquia. Facultad de Medicina, Medellin, Antioquia, Colombia. williamco@epm.net.co

INTRODUCTION: Cyanocobalamin (vitamin B12) is an essential cofactor of various metabolic pathways. Lack of it leads to symptoms which may be constitutional, of skin or mucous membranes, hematological or neuropsychiatric disorders. Neurological involvement in adults has been well described and analyzed in the literature, however there are fewer cases of children. In the cases described in children the deficiency was related to maternal malnutrition, and socioeconomic and cultural problems. Since vegetarianism is a custom followed by different social groups we wish to draw attention to this as a cause of vitamin B12 deficiency and the neurological disorder this may cause. CLINICAL CASE: We describe the case of a 10 year old boy, a member of a religious community who were strict vegetarians. Over three months he developed: a cognitive disorder, pyramidal syndrome of his legs, involvement of the posterior spinal cord, peripheral motor and sensory alterations which, together with the complementary investigations, was found to be compatible with subacute combined degeneration due to vitamin B12 deficiency. CONCLUSION: We draw attention to the clinical and laboratory aspects of this disorder and the importance of taking the possibility of this diagnosis into account in children with nutritional risk factors.

PMID: 11785055 [PubMed - indexed for MEDLINE]

[Macrocytic anemia and neurological signs due to vitamin B-12 deficiency in a breast-fed infant of a strict vegetarian mother]

• Fogarasi A,
• Neuwirth M,
• Bekesi A,
• Bocskai E.

Neurologiai Osztaly, Magyarorszagi Reformatus Egyhaz Bethesda Gyermekkorhaza, Budapest.

Vitamin B12 deficiency is a very rare disease of infants and young children in Europe. Authors report a case of a 9.5-month-old infant who was exclusively breast-fed by his vegan mother and developed serious vitamin B12 deficiency in form of neurological regression, repetitive vomiting, drowsiness, dysphagia, obstipation, and tremor. A few days after intramuscular vitamin substitution his abnormal signs improved dramatically, hematological restitution was reached in six weeks. Authors describe the hematological and neurological signs, the diagnostic and differential-diagnostic pitfalls, therapy, prognosis, and prevention of this condition. Beside reviewing the literature they emphasize the importance of early recognition and intervention and the need of an appropriate doctor-parent cooperation in this disease.

PMID: 11770177 [PubMed - indexed for MEDLINE]

Comment in:

Am J Clin Nutr. 2001 Aug;74(2):157-9.

Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians.

• Refsum H,
• Yajnik CS,
• Gadkari M,
• Schneede J,
• Vollset SE,
• Orning L,
• Guttormsen AB,
• Joglekar A,
• Sayyad MG,
• Ulvik A,
• Ueland PM.

Department of Pharmacology and the Locus for Homocysteine and Related Vitamins, University of Bergen, Norway. helga.refsum@farm.uib.no

BACKGROUND: In India, most people adhere to a vegetarian diet, which may lead to cobalamin deficiency. OBJECTIVE: The objective was to examine indicators of cobalamin status in Asian Indians. DESIGN: The study population included 204 men and women aged 27-55 y from Pune, Maharashtra, India, categorized into 4 groups: patients with cardiovascular disease (CVD) and diabetes, patients with CVD but no diabetes, patients with diabetes but no CVD, and healthy subjects. Data on medical history, lifestyle, and diet were obtained by interviews and questionnaires. Blood samples were collected for measurement of serum or plasma total cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine (tHcy) and hemetologic indexes. RESULTS: MMA, tHcy, total cobalamin, and holoTC did not differ significantly among the 4 groups; therefore, the data were pooled. Total cobalamin showed a strong inverse correlation with tHcy (r = -0.59) and MMA (r = -0.54). Forty-seven percent of the subjects had cobalamin deficiency (total cobalamin <150 pmol/L), 73% had low holoTC (<35 pmol/L), 77% had hyperhomocysteinemia (tHcy >15 micromol/L), and 73% had elevated serum MMA (>0.26 micromol/L). These indicators of impaired cobalamin status were observed in both vegetarians and nonvegetarians. Folate deficiency was rare and only 2.5% of the subjects were homozygous for the MTHFR 677C-->T polymorphism. CONCLUSIONS: About 75% of the subjects had metabolic signs of cobalamin deficiency, which was only partly explained by the vegetarian diet. If impaired cobalamin status is confirmed in other parts of India, it may have important health implications.

PMID: 11470726 [PubMed - indexed for MEDLINE]

Reversible subacute combined degeneration of the spinal cord in a 14-year-old due to a strict vegan diet.

• Licht DJ,
• Berry GT,
• Brooks DG,
• Younkin DP.

Department of Pediatrics, Children's Hospital of Philadelphia, PA 19104, USA.

PMID: 11491139 [PubMed - indexed for MEDLINE]

Total homocysteine, vitamin B(12), and total antioxidant status in vegetarians.

• Herrmann W,
• Schorr H,
• Purschwitz K,
• Rassoul F,
• Richter V.

Department of Clinical Chemistry/Central Laboratory, University Hospital of the Saarland, D-66421 Homburg/Saar, Germany. kchwher@med-rz-uni-sb.de

BACKGROUND: Decreasing or eliminating animal products from the diet decreases the intake of some essential nutrients, such as vitamin B(12), which may lead to hyperhomocysteinemia. We investigated vitamin B(12)-dependent metabolism and oxidative stress in groups with various or no intake of meat or animal products. METHODS: We investigated 44 high meat eaters, 19 low meat eaters, 34 lacto-ovo/lacto vegetarians, and 7 vegan vegetarians. Homocysteine (HCY) was assayed by HPLC, methylmalonic acid (MMA) by capillary gas chromatography-mass spectrometry, serum folate and vitamin B(12) with a chemiluminescence immunoassay, and total antioxidant status (TAS) by a Randox method. RESULTS: The mean serum HCY concentration of vegetarians was significantly increased, and in vegans the median concentration exceeded 15 micromol/L. Vegetarians had a higher serum concentration of MMA but a lower TAS. Vitamin B(12) and folate did not differ significantly between vegetarian and omnivorous subjects. Overall, HCY and MMA were significantly correlated. Vitamin B(12) correlated negatively with MMA, HCY, and folate, whereas the correlation with TAS was positive. Backward regression analysis revealed an independent influence of MMA on HCY, of HCY and vitamin B(12) on MMA, and of vitamin B(12) on TAS. The increased MMA concentration suggested a 25% frequency of functional vitamin B(12) deficiency in all vegetarians. Serum vitamin B(12) was below the lower reference limit in only five subjects. CONCLUSIONS: Functional vitamin B(12) deficiency in vegetarians may contribute to hyperhomocysteinemia and decreased TAS, which may partly counteract the beneficial lifestyle of vegetarians. However, increased serum HCY is most likely not responsible for the lower TAS values in vegetarians. We recommend assaying of MMA and HCY to investigate functional vitamin B(12) status.

PMID: 11375297 [PubMed - indexed for MEDLINE]

Growth and nutrition of Chinese vegetarian children in Hong Kong.

• Leung SS,
• Lee RH,
• Sung RY,
• Luo HY,
• Kam CW,
• Yuen MP,
• Hjelm M,
• Lee SH.

Department of Paediatrics, The Chinese University of Hong Kong, Shatin, Hong Kong. sophie-leung@cuhk.edu.hk

OBJECTIVE: The study investigated the nutritional status of Chinese lacto-ovo-vegetarian children aged 4-14 years. METHODOLOGY: Dietary intake over 7 days was assessed using a computer program, previously used for a local population-based dietary survey. Anthropometric measurements were made and fasting venous blood was examined for serum lipids, haematological data, iron, vitamin B12 and folate status. Bone mineral density (BMD) of the spine (L2 - L4) was measured as a reflection of calcium status. RESULTS: Fifty-one lacto-ovo-vegetarians aged 4-14 years were investigated. The mean +/- standard deviation (SD) daily energy intake was 1600 +/- 425 kcal. The mean (+/- SD) daily protein intake was 1.6 +/- 0.6 g/kg bodyweight which met the United States recommended dietary allowance. Compared to that of the local omnivore diet, the vegetarian diet was closer to the recommended healthy diet with lower fat (20-23%), more fibre (5.8-8.7 g/day) and better polyunsaturated to saturated fatty acid ratio (1.0-1.1). Growth and BMD of the vegetarian children were comparable to the general omnivore population. Two children had iron deficiency and two children had anaemia. The calcium status, as reflected by the BMD, was not impaired. Serum folate and vitamin B12 were within the normal range. Six (25%) boys and four (15%) girls were obese. Three boys had hyperlipidaemia. CONCLUSIONS: A Hong Kong Chinese vegetarian diet appears healthy, providing adequate iron and vitamin B12 nutrition, but the prevalence of obesity was high.

PMID: 11468039 [PubMed - indexed for MEDLINE]

An unusual clinical presentation of cobalamine deficiency.

• Rohatgi A,
• Sachdeva S,
• Kulshrestha M.

PMID: 11762639 [PubMed - indexed for MEDLINE]

Erratum in:

J Nutr 2001 May;131(5):1586.

Folate status during pregnancy in women is improved by long-term high vegetable intake compared with the average western diet.

• Koebnick C,
• Heins UA,
• Hoffmann I,
• Dagnelie PC,
• Leitzmann C.

Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Waldstrasse 6, D-91054 Erlangen, Germany. Corinna.Koebnick@imbe.imed.uni-erlangen.de

The effect of increasing dietary folate on folate status during pregnancy is controversial. The aim of this study was to compare folate intake and folate status during pregnancy of women with high long-term vegetable intake and those eating an average Western diet. In a prospective study that included 109 participants, pregnant women adhering to a predominant vegetarian diet with high vegetable intake for 8 +/- 0.5 y with subgroups of ovo-lacto vegetarians (n = 27) and low meat eaters (n = 43) and women eating an average Western diet (control group, n = 39) were compared with regard to dietary intake and plasma and red blood cell (RBC) folate concentrations during wk 9-12, 20-22 and 36-38 of gestation. Plasma and RBC folate concentrations were highest in ovo-lacto vegetarians, followed by low meat eaters and lowest in the controls. Ovo-lacto vegetarians and low meat eaters showed a lower risk for folate deficiency, with RBC folate concentrations of <320 nmol/L resulting in odds ratios of 0.10 (95% confidence interval, 0.01-0.56) and 0.52 (95% confidence interval, 0.20-1.34), respectively. In ovo-lacto vegetarians, the RBC folate concentration was positively related to the intake of vitamin B-12 (r = 0.51, P: < 0.0001). The results of the study suggest that long-term high vegetable intake favorably affects plasma folate as well as RBC folate concentrations throughout pregnancy and reduces the risk of folate deficiency if an adequate vitamin B-12 supply is ensured.

PMID: 11238752 [PubMed - indexed for MEDLINE]

[Are vegetarian diets safe?]

• Rauma AL.

Joensuun yliopisto, SOKL PL 55, 57101 Savonlinna. anna-liisa.rauma@joensuu.fi

PMID: 12092345 [PubMed - indexed for MEDLINE]

Traditional and alternative nutrition--levels of homocysteine and lipid parameters in adults.

• Krajcovicova-Kudlackova M,
• Blazicek P,
• Babinska K,
• Kopcova J,
• Klvanova J,
• Bederova A,
• Magalova T.

Institute of Preventive and Clinical Medicine, Bratislava, Slovak Republic.

Values of homocysteine and lipid parameters were measured in groups of adults consuming alternative nutrition (vegetarians/lactoovo/, vegans) and compared with a group consuming traditional diet (omnivores, general population). Frequency of hyperhomocysteinemia was 53% in the vegans group, 28% in vegetarians vs. 5% in omnivores. In conditions of lower methionine intake (reduced content in plant proteins), the remethylation pathway of homocysteine metabolism prevails and it is vitamin B12 and folate-dependent. The intake of vitamin B12 is equal to zero in vegans; vegetarians consume 124% of the RDA vs. 383% in omnivores. Serum vitamin levels are significantly lower in subjects consuming alternative nutrition with deficiency observed in 24% of vegetarians, 78% of vegans vs. 0% in omnivores. Serum folate levels are within the reference range in all groups. Mild hyperhomocysteinemia in the groups consuming alternative diet is a consequence of vitamin B12 deficiency. Vegetarians and vegans meet the RDA for energy and fat, and have a favourable proportion of saturated, mono- and polyunsaturated fatty acids on total energy intake; the ratio of linoleic/alpha-linolenic acid in their diet corresponds with the recommendations. They have low cholesterol consumption and higher vitamin E and C intake. Optimal fat intake of correct composition is reflected in lower values of atherosclerosis risk factors (cholesterol, LDL-cholesterol, atherogenic index, saturated fatty acids, triacylglycerols), and significantly higher levels of protective substances (linoleic acid, alpha-linolenic acid, HDL-cholesterol, vitamin E, vitamin E/cholesterol, vitamin C). Low lipid risk factors but higher findings of mild hyperhomocysteinemia in vegetarians mean a diminished protective effect of alternative nutrition in cardiovascular disease prevention.

PMID: 11218148 [PubMed - indexed for MEDLINE]

Cardiovascular risk factors in vegetarians. Normalization of hyperhomocysteinemia with vitamin B(12) and reduction of platelet aggregation with n-3 fatty acids.

• Mezzano D,
• Kosiel K,
• Martinez C,
• Cuevas A,
• Panes O,
• Aranda E,
• Strobel P,
• Perez DD,
• Pereira J,
• Rozowski J,
• Leighton F.

Departments of Hematology-Oncology, Catholic University of Chile, Santiago, Chile. dmezzano@med.puc.cl

Hyperhomocysteinemia in association with vitamin B(12) deficiency, and increased platelet aggregation, probably due to dietary lack of n-3 fatty acids, constitute cardiovascular risk factors frequently observed in vegetarians. We tested if administration of vitamin B(12) normalizes the concentration of total plasma homocysteine, and if intake of eicosapentaenoic (20:5n-3) and docosahexaenoic (22:6n-3) fatty acids modulates platelet function in a population of lactoovovegetarians. One week after a single intramuscular injection of cyanocobalamin (10000 microg) in 18 individuals, serum vitamin B(12) increased from 149+/-63 pg/mL to 532+/-204 pg/mL (p<0.0001) and total tHcy dropped from 12.4+/-4.7 to 7.9+/-3.1 micromol/L (p<0. 0001). Ten of fourteen of these vegetarians completed an 8-week supplementation with 700 mg/day of each eicosapentaenoic and docosahexaenoic acids. Increased incorporation of these fatty acids into plasma lipids was observed in all of them, together with a significant reduction in maximum percentage or slope of platelet aggregation with all the agonists tested (ADP, epinephrin, collagen, arachidonic acid). No significant change in bleeding time was observed after n-3 fatty acid trial. Supplementation with vitamin B(12) and n-3 fatty acids corrects hyperhomocysteinemia and reduces platelet reactivity to agonists in vegetarians. Whether this supplementation improves the already reduced cardiovascular morbidity and mortality associated with vegetarian diet has yet to be demonstrated.

PMID: 11108902 [PubMed - indexed for MEDLINE]

Signs of impaired cognitive function in adolescents with marginal cobalamin status.

• Louwman MW,
• van Dusseldorp M,
• van de Vijver FJ,
• Thomas CM,
• Schneede J,
• Ueland PM,
• Refsum H,
• van Staveren WA.

Division of Human Nutrition and Epidemiology, Wageningen Agricultural University, Netherlands.

BACKGROUND: Lack of cobalamin may lead to neurologic disorders, which have been reported in strict vegetarians. OBJECTIVE: The objective of this study was to investigate whether cognitive functioning is affected in adolescents (aged 10-16 y) with marginal cobalamin status as a result of being fed a macrobiotic diet up to an average age of 6 y. DESIGN: Data on dietary intake, psychological test performance, and biochemical variables of cobalamin status were collected from 48 adolescents who consumed macrobiotic (vegan type) diets up to the age of 6 y, subsequently followed by lactovegetarian or omnivorous diets, and from 24 subjects (aged 10-18 y) who were fed omnivorous diets from birth onward. Thirty-one subjects from the previously macrobiotic group were cobalamin deficient according to their plasma methylmalonic acid concentrations. Seventeen previously macrobiotic subjects and all control subjects had normal cobalamin status. RESULTS: The control subjects performed better on most psychological tests than did macrobiotic subjects with low or normal cobalamin status. A significant relation between test score and cobalamin deficiency (P: = 0.01) was observed for a test measuring fluid intelligence (correlation coefficient: -0.28; 95% CI: -0.48, -0.08). This effect became more pronounced (P: = 0.003) within the subgroup of macrobiotic subjects (correlation coefficient: -0.38; 95% CI: -0.62, - 0.14). CONCLUSION: Our data suggest that cobalamin deficiency, in the absence of hematologic signs, may lead to impaired cognitive performance in adolescents.

PMID: 10966896 [PubMed - indexed for MEDLINE]

Metabolic vitamin B12 status on a mostly raw vegan diet with follow-up using tablets, nutritional yeast, or probiotic supplements.

• Donaldson MS.

Hallelujah Acres Foundation, Shelby, N.C., USA. michael@hacres.com

BACKGROUND: Pure vegetarian diets might cause cobalamin deficiency due to lack of dietary intake. It was hypothesized that a population following a vegan diet consuming mostly raw fruits and vegetables, carrot juice, and dehydrated barley grass juice would be able to avoid vitamin B12 deficiency naturally. METHODS: Subjects were recruited at a health ministers' reunion based on adherence to the Hallelujah diet for at least 2 years. Serum cobalamin and urinary methylmalonic acid (MMA) assays were performed. Follow-up with sublingual tablets, nutritional yeast, or probiotic supplements was carried out on subjects with abnormal MMA results. RESULTS: 49 subjects were tested. Most subjects (10th to 90th percentile) had followed this diet 23-49 months. 6 subjects had serum B12 concentrations <147 pmol/l (200 pg/ml). 37 subjects (76%) had serum B12 concentrations <221 pmol/l (300 pg/ml). 23 subjects (47%) had abnormal urinary MMA concentrations above or equal to 4.0 microg/mg creatinine. Sublingual cyanocobalamin and nutritional yeast, but not probiotic supplements, significantly reduced group mean MMA concentrations (tablet p < 0.01; yeast p < 0.05, probiotic > 0.20). CONCLUSIONS: The urinary MMA assay is effective for identifying early metabolic cobalamin deficiency. People following the Hallelujah diet and other raw-food vegetarian diets should regularly monitor their urinary MMA levels, consume a sublingual cobalamin supplement, or consume cobalamin in their food.

PMID: 11146329 [PubMed - indexed for MEDLINE]

Homocysteine levels in vegetarians versus omnivores.

• Krajcovicova-Kudlackova M,
• Blazicek P,
• Kopcova J,
• Bederova A,
• Babinska K.

Institute of Preventive and Clinical Medicine, Bratislava, Slovak Republic.

Vitamin B(12), folate, and vitamin B(6) are the main determinants of homocysteinemia. The vegan diet provides no vitamin B(12), but also less strict forms of alternative nutrition may suffer from a deficit of this vitamin. The plasma homocysteine level was measured in alternative nutrition groups of adults (lacto- and lactoovovegetarians, n = 62; vegans, n = 32) and compared with the levels in a group consuming traditional diet (n = 59), omnivores). In the group of vegetarians the average homocysteine level is 13.18 vs. 10.19 micromol/l in omnivores; the frequency of hyperhomocysteinemia is 29 vs. 5% in omnivores. In the group of vegans the average homocysteine value is 15.79 micromol/l (53% of the individual values exceeded 15 micromol/l). Omnivores consume the recommended amount of methionine; however, in individuals consuming an alternative diet, the intake of methionine is deficient (assessed by food frequency questionnaire; lower content of methionine in plant proteins). Under conditions of lower methionine availability the remethylation pathway prevails; therefore, vitamin B(12) and folate were evaluated in relation to the homocysteine level. The serum vitamin B(12) levels are significantly lower in the alternative nutrition groups (214.8 pmol/l in vegetarians, 140.1 pmol/l in vegans vs. 344.7 pmol/l in omnivores); a deficit (<179.0 pmol/l) was found in 26% of the vegetarians and in 78% of the vegans vs. 0% in omnivores. The serum folate levels were within the range of reference values in all groups; however, they were significantly lower in omnivores. The results show that the mild hyperhomocysteinemia in alternative nutrition is a consequence of vitamin B(12) deficiency. Copyright 2000 S. Karger AG, Basel

PMID: 11053901 [PubMed - indexed for MEDLINE]

Cyanocobalamin (vitamin B-12) status in Seventh-day Adventist ministers in Australia.

• Hokin BD,
• Butler T.

Pathology Department, Sydney Adventist Hospital and Adventist Health Department, Wahroonga, Australia. bevan@sah.org.au

As part of the Adventist Ministers' Health Study, a series of cross-sectional surveys conducted in 1992, 1994, and 1997, the serum vitamin B-12 status of 340 Australian Seventh-day Adventist ministers was assessed in 1997. The ministers in the study participated voluntarily. Of this group, 245 were either lactoovovegetarians or vegans who were not taking vitamin B-12 supplements. Their mean vitamin B-12 concentration was 199 pmol/L (range: 58-538 pmol/L), 53% of whom had values below the reference range for the method used (171-850 pmol/L) and 73% of whom had values <221 pmol/L, the lower limit recommended by Herbert. Dual-isotope Schillings test results in 36 lactoovovegetarians with abnormally low vitamin B-12 concentrations indicated that dietary deficiency was the cause in 70% of cases. Data from the dietary questionnaires supported dietary deficiency as the cause of low serum vitamin B-12 in this population of lactoovovegetarians and vegans, 56 (23%) of whom consumed sufficient servings of vitamin B-12-containing foods to obtain the minimum daily maintenance allowance of the vitamin (1 microg).

PMID: 10479234 [PubMed - indexed for MEDLINE]

Risk of persistent cobalamin deficiency in adolescents fed a macrobiotic diet in early life.

• van Dusseldorp M,
• Schneede J,
• Refsum H,
• Ueland PM,
• Thomas CM,
• de Boer E,
• van Staveren WA.

Division of Human Nutrition and Epidemiology, Wageningen Agricultural University, Netherlands. Marijke.vandusseldorp@staff.nutepi.wau.nl

BACKGROUND: Cobalamin deficiency has been described in children consuming macrobiotic diets. OBJECTIVE: We investigated whether moderate consumption of animal products is sufficient for achieving normal cobalamin function in 73 adolescents who had received a macrobiotic diet until 6 y of age and had then switched to a lactovegetarian, lactoovovegetarian, or omnivorous diet (macrobiotic adolescents). DESIGN: Hematologic indexes and serum concentrations of methylmalonic acid (MMA), total homocysteine (tHcy), and folate were measured. Current consumption frequency of animal products and cobalamin intake from dairy products were assessed by questionnaire. Data from 94 age-matched adolescents who received an omnivorous diet from birth were used as a reference. RESULTS: Serum cobalamin concentrations were significantly lower and concentrations of MMA and folate and mean corpuscular volume (MCV) were significantly higher in macrobiotic adolescents than in control adolescents: of macrobiotic adolescents, 21% had abnormal MMA concentrations (>0.41 micromol/L), 37% had abnormal cobalamin concentrations (<218 pmol/L), 10% had abnormal tHcy concentrations (> 12.8 micromol/L), and 15% had abnormal MCV (> 89 fL). In macrobiotic adolescents, dairy products (200 g milk or yogurt and 22 g cheese/d) supplied on average 0.95 microg cobalamin/d; additionally, these adolescents consumed fish, meat, or chicken 2-3 times/wk. In girls, meat consumption contributed more to cobalamin status than the consumption of dairy products, whereas in boys these food groups were equally important. CONCLUSIONS: A substantial number of the formerly strict macrobiotic adolescents still had impaired cobalamin function. Thus, moderate consumption of animal products is not sufficient for restoring normal cobalamin status in subjects with inadequate cobalamin intake during the early years of life.

PMID: 10197567 [PubMed - indexed for MEDLINE]

Hematological parameters, ferritin and vitamin B12 in vegetarians.

• Pongstaporn W,
• Bunyaratavej A.

Department of Clinical Microscopy, Faculty of Medical Technology, Rangsit University, Pathumthani, Thailand.

Hematological parameters and serum ferritin were compared between 179 vegetarians and 58 control subjects using Hematology analyzer H3 and microparticle enzyme immunoassay, respectively. Serum Vitamin B12 was also compared between 68 vegetarians and 30 control subjects using microparticle enzyme immunoassay. It was found that hemoglobin, hematocrit, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, white blood cells, neutrophils, serum ferritin and serum vitamin B12 in vegetarian were significantly lower than control subjects (P < 0.05). In addition, red cell distribution width and lymphocytes in vegetarians were significantly higher than control subjects (P < 0.05). There were 34 cases of iron deficiency in 179 vegetarians (19.%) which can be classified to iron depletion (4 cases), iron deficient erythropoiesis (12 cases) and iron deficiency anemia (18 cases). Vitamin B12 deficiency was found in 27 cases of 68 vegetarians (40%).

PMID: 10410487 [PubMed - indexed for MEDLINE]

Neuropathy in two cobalamin-deficient breast-fed infants of vegetarian mothers.

• Renault F,
• Verstichel P,
• Ploussard JP,
• Costil J.

Service de neurophysiologie clinique de l'enfant, hopital Armand-Trousseau, Paris, France.

We describe the electrophysiological findings in 2 infants with deficient cobalamin intake. After normal development, psychomotor regression appeared after the 6th month, leading to severe hypotonia and apathy before the 12th month. Electrodiagnostic evaluation showed sensory neuropathy in both cases, associated with motor neuropathy in 1 case. Thus, in an acquired floppy infant syndrome, electrophysiological signs of peripheral neuropathy contributed to the diagnosis of a curable metabolic disorder.

PMID: 10024138 [PubMed - indexed for MEDLINE]

Comment on:

J Nutr. 1995 Oct;125(10):2511-5.

Some algae are potentially adequate sources of vitamin B-12 for vegans.

• Dagnelie PC.

PMID: 9039844 [PubMed - indexed for MEDLINE]

Retardation of myelination due to dietary vitamin B12 deficiency: cranial MRI findings.

• Lovblad K,
• Ramelli G,
• Remonda L,
• Nirkko AC,
• Ozdoba C,
• Schroth G.

Department of Neuroradiology, IDR, Inselspital, University of Bern, Freiburgstrasse, CH-3010 Bern, Switzerland.

Vitamin B12 deficiency is known to be associated with signs of demyelination, usually in the spinal cord. Lack of vitamin B12 in the maternal diet during pregnancy has been shown to cause severe retardation of myelination in the nervous system. We report the case of a 14(1)/2-month-old child of strictly vegetarian parents who presented with severe psychomotor retardation. This severely hypotonic child had anemia due to insufficient maternal intake of vitamin B12 with associated megaloblastic anemia. MRI of the brain revealed severe brain atrophy with signs of retarded myelination, the frontal and temporal lobes being most severely affected. It was concluded that this myelination retardation was due to insufficient intake of vitamin B12 and vitamin B12 therapy was instituted. The patient responded well with improvement of clinical and imaging abnormalities. We stress the importance of MRI in the diagnosis and follow-up of patients with suspected diseases of myelination.

PMID: 9028851 [PubMed - indexed for MEDLINE]

The neurological syndrome of infantile cobalamin deficiency: developmental regression and involuntary movements.

• Grattan-Smith PJ,
• Wilcken B,
• Procopis PG,
• Wise GA.

Department of Paediatric Neurology, Westmead Hospital, Sydney, Australia.

Developmental regression is the presenting symptom of most infants with cobalamin (Vitamin B12) deficiency. We present a report of three infants with cobalamin deficiency in which the infants also developed a movement disorder. In each case the mother was a vegetarian and the infant was exclusively breast-fed. In two of the infants, a striking movement disorder consisting of a combination of tremor and myoclonus particularly involving face, tongue, and pharynx appeared 48 h after the initiation of treatment with intramuscular cobalamin. This was associated with marked changes in plasma amino acid levels. Paradoxically, the onset of the movement disorder coincided with overall neurological improvement. The third infant had a persistent focal tremor, which appeared before the commencement of treatment. The movements slowly abated during a 3-6 week period. The presence of a movement disorder in cobalamin deficiency has received less attention than other features, but in a mild form is probably common. It may offer an early clue to the diagnosis before the onset of profound neurological deterioration. The cause of the severe movement disorder that can appear after treatment is not known.

PMID: 8990052 [PubMed - indexed for MEDLINE]

Serum vitamin B12 levels in young vegans who eat brown rice.

• Suzuki H.

Department of Internal Medicine, Social Insurance Institute of Nagahori, Clinic, Osaka, Japan.

A nutritional analysis was conducted on the dietary intake of a group of 6 vegan children aged 7 to 14 who had been living on a vegan diet including brown rice for from 4 to 10 years, and on that of an age-matched control group. In addition, their serum vitamin B12 levels and other data (red blood cell count, hematocrit, hemoglobin, etc.) were determined in the laboratory. In vegans' diets, 2-4 g of nori (dried laver), which contained B12, were consumed daily. Not a single case of symptoms due to B12 deficiency was found. There were no statistically significant differences between the two groups with respect to any of the examination data, including B12 levels (p < 0.05). Therefore, consumption of nori may keep vegans from suffering B12 deficiency.

PMID: 8926531 [PubMed - indexed for MEDLINE]

[Vegetarians and vitamin B12. A controlled trial of vitamin B12 status in 63 lactovegetarians]

• Solberg EE,
• Magnus E,
• Sander J,
• Loeb M.

Medisinsk klinikk, Ulleval sykehus, Oslo.

In this study vitamin B12 status was assessed in 63 adult long-term lactovegetarians and 63 controls. No significant difference in mean plasma levels of vitamin B12 was found between the two groups. In contrast to what might have been expected, the vegetarians showed a slight increase in the vitamin B12 levels with increasing number of years as vegetarians. There was a significant (r = 0.34, p = 0.01) correlation between oral intake of vitamin B12 in the lactovegetarians and the plasma levels of the vitamin. Folate in plasma and whole blood were significantly higher (p < 0.001) in the vegetarian group than in the control group. The findings do not indicate that lactovegetarians risk developing dietary-induced vitamin B12 deficiency.

PMID: 7985175 [PubMed - indexed for MEDLINE]

Staging vitamin B-12 (cobalamin) status in vegetarians.

• Herbert V.

Mount Sinai Medical Center, New York City.

When one stops eating vitamin B-12 (cobalamins), one passes through four stages of negative cobalamin balance: serum depletion [low holotranscobalamin II, ie, low vitamin B-12 on transcobalamin II (TCII)], cell depletion (decreasing holohaptocorrin and low red cell vitamin B-12 concentrations), biochemical deficiency (slowed DNA synthesis, elevated serum homocysteine and methylmalonate concentrations), and, finally, clinical deficiency (anemia). Serum vitamin B-12 is on two proteins: the circulating vitamin B-12 delivery protein, TCII, and the circulating vitamin B-12 storage protein, haptocorrin. Because TCII is depleted of vitamin B-12 within days after absorption stops, the best screening test for early negative vitamin B-12 balance is a measurement of vitamin B-12 on TCII (holoTCII). HoloTCII falls below the bottom of its normal range long before total serum vitamin B-12 (which is mainly vitamin B-12 on haptocorrin) falls below the bottom of its normal range.

PMID: 8172125 [PubMed - indexed for MEDLINE]

Nutritional concerns of lactating women consuming vegetarian diets.

• Specker BL.

University of Cincinnati Medical Center, Department of Pediatrics, OH 45267-0541.

Nutritional inadequacies during lactation may affect the well-being of the mother, infant, or both. Vitamin D and calcium status in vegetarian women may be low, resulting in maternal bone demineralization. Vitamin B-12 deficiency resulting in neurologic damage has been reported in infants of vegetarian women. A review of several studies completed on women in the northeastern United States who were consuming a macrobiotic diet is presented. Supplemental vitamin D does not appear to be necessary given sufficient sun exposure. Calcium intake in vegetarian mothers was low and differences in calcium-regulating hormones were apparent. However, it is not clear whether these hormonal changes resulted in adequate adaptation whether these hormonal changes resulted in adequate adaptation and prevented bone demineralization. The low calcium intake in the vegetarian women did not result in lower milk calcium concentrations. Elevated methylmalonic acid excretion, which is often seen in vitamin B-12 deficiency, was noted in the vegetarian mothers and their infants. Infants with high methylmalonic acid excretion were consuming milk low in vitamin B-12.

PMID: 8172121 [PubMed - indexed for MEDLINE]

Vitamin B12, folic acid and haematological status of 132 Thai vegetarians.

• Tungtrongchitr R,
• Pongpaew P,
• Prayurahong B,
• Changbumrung S,
• Vudhivai N,
• Migasena P,
• Schelp FP.

Department of Tropical Nutrition and Food Science, Faculty of Tropical Medicine, Mahidol University.

Serum vitamin B12, folic acid and haematological variables of 132 Thai vegetarians (64 males and 68 females) were investigated. Forty-seven healthy omnivorous individuals served as controls. No statistical differences in haemoglobin concentration, packed red cell volume and mean corpuscular haemoglobin concentration between the vegetarians and controls had been detected. In the female vegetarians, the haemoglobin concentration and packed red cell volume were, however, statistically lower. No significant differences in the white cell counts and platelet counts were observed in both groups. A significant increase of basophilic stippling and reticulocytes was observed in the vegetarians. Serum vitamin B12 decreased and serum folic acid levels increased according to the duration of vegetarianism in the vegetarians. In the females practicing vegetarianism for 6-10 years or more, the proportion of serum vitamin B12 deficiencies was particularly high. The high percentage of vitamin B12 deficiency in the vegetarians might be related to megaloblastic anaemia. This form of anaemia is commonly associated with the presence of basophilic stippling. Therefore, the increased presence of basophilic stippling and reticulocytes might indicate a mild stage of this type of anaemia among the vegetarians.

PMID: 8300331 [PubMed - indexed for MEDLINE]

Long-term neurologic consequences of nutritional vitamin B12 deficiency in infants.

• Graham SM,
• Arvela OM,
• Wise GA.

Prince of Wales Children's Hospital, Randwick, Australia.

A review of the clinical findings in six infants with nutritional vitamin B12 deficiency seen during the last 10 years was undertaken and an attempt made to obtain long-term neurologic follow-up. There was a consistent clinical pattern in vitamin B12-deficient infants; irritability, anorexia, and failure to thrive were associated with marked developmental regression and poor brain growth. Two of the four patients who qualified for long-term review had a poor intellectual outcome. Although early response to treatment is satisfying, the long-term consequences of nutritional vitamin B12 deficiency in infants emphasize the need for prevention or early recognition of this syndrome.

PMID: 1432418 [PubMed - indexed for MEDLINE]

The hematological and electrophysiological effects of cobalamin. Deficiency secondary to vegetarian diets.

• Gilois C,
• Wierzbicki AS,
• Hirani N,
• Norman PM,
• Jones SJ,
• Ponsford S,
• Alani SM,
• Kriss A.

Department of Haematology, National Hospital for Neurology, Queen Square, London, United Kingdom.

PMID: 1444044 [PubMed - indexed for MEDLINE]

Maternal vegan diet causing a serious infantile neurological disorder due to vitamin B12 deficiency.

• Kuhne T,
• Bubl R,
• Baumgartner R.

University Children's Hospital Basel, Switzerland.

We present a 9-month-old exclusively breast-fed baby of a strict vegetarian mother who had excluded all animal proteins from her diet. The patient's symptoms included dystrophy, weakness, muscular atrophy, loss of tendon reflexes, psychomotor regression and haematological abnormalities. Biochemical investigations revealed severe methylmalonic aciduria and homocystinuria in the patient, slight methylmalonic aciduria in the mother and low concentrations of serum vitamin B12 in both patient and mother.

PMID: 2044594 [PubMed - indexed for MEDLINE]

Vitamin B12 and folate levels in long-term vegans.

• Bar-Sella P,
• Rakover Y,
• Ratner D.

Nutrition Clinic, Central Emek Hospital, Afula, Israel.

Serum vitamin B12, serum folate and red blood cell (RBC) folate levels were examined among 36 strict vegans of 5-35 years' duration. Vitamin B12 levels among the vegans were generally lower than in a control population. Most of the vegans had vitamin B12 values less than 200 pg/ml. RBC folate levels were normal but serum folate levels among the vegans were higher than among the controls. None of the vegans had any hematologic evidence of vitamin B12 deficiency, however four of them had neurologic complaints. Long-standing vegans should be monitored for vitamin B12 levels.

PMID: 2380031 [PubMed - indexed for MEDLINE]

Increased risk of vitamin B-12 and iron deficiency in infants on macrobiotic diets.

• Dagnelie PC,
• van Staveren WA,
• Vergote FJ,
• Dingjan PG,
• van den Berg H,
• Hautvast JG.

Department of Human Nutrition, Wageningen Agricultural University, The Netherlands.

The blood iron, vitamin B-12, and folate status of the 1985 birth cohort of Dutch infants aged 10.1-20.4 mo fed macrobiotic diets (n = 50) and matched omnivorous control infants (n = 57) was measured. Fe deficiency (combination of Hb less than 120 g/L, ferritin less than 12 micrograms/L, and FEP greater than 1.77 mumol/L) was observed in 15% of the macrobiotic group but not in the control group (p = 0.003). Plasma vitamin B-12 concentrations in the macrobiotic group were far below those of the control group (geometrical mean: 149 and 404 pmol/L, respectively, p less than 0.001). Plasma folate concentrations were higher in the macrobiotic group (31.6 +/- 11.7 nmol/L) than in the control group (21.1 +/- 8.8 nmol/L, p less than 0.001). In the macrobiotic group mean corpuscular volume, mean corpuscular hemoglobin mass, and mean corpuscular hemoglobin concentration were higher and hematocrit and red blood cells were lower (all p less than 0.05) than in the control group. It is advised to incorporate regular servings of animal foods into the macrobiotic diet to obtain an adequate amount of vitamin B-12.

PMID: 2801586 [PubMed - indexed for MEDLINE]

Nutritional vitamin B12 deficiency in infancy: three case reports and a review of the literature.

• Doyle JJ,
• Langevin AM,
• Zipursky A.

Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario.

Three cases of vitamin B12 deficiency that occurred during infancy are presented. These cases appeared to be the result of pre-existing maternal deficiency. All three infants demonstrated evidence of neurodevelopmental delay at presentation, and one had sustained loss of milestones and developed involuntary motor movements. Prior to the initiation of therapy, all three infants were anemic: one was thrombocytopenic and one pancytopenic. In all three cases the hematologic and neurologic abnormalities were corrected with vitamin B12 therapy. The literature is reviewed and discussed with respect to the mechanism of the infants' vitamin B12 deficiency and neurodevelopmental manifestations.

PMID: 2702070 [PubMed - indexed for MEDLINE]

Increased urinary methylmalonic acid excretion in breast-fed infants of vegetarian mothers and identification of an acceptable dietary source of vitamin B-12.

• Specker BL,
• Miller D,
• Norman EJ,
• Greene H,
• Hayes KC.

Department of Pediatrics, University of Cincinnati Medical Center, OH 45267-0541.

Increased urinary methylmalonic acid (UMMA) concentrations might indicate vitamin B-12 deficiency. Our study tested the hypothesis that elevated UMMA in breast-fed infants is associated with decreased maternal serum B-12 concentrations. UMMA concentrations were measured in 17 vegetarian mothers and their infants and in six infants of nonvegetarian mothers. Serum vitamin B-12 concentrations were determined in all mothers. Range of UMMA for vegetarian infants (3-924 mcg/mg [2.6-790.9 mumol/mmol] creatinine) was much broader than that for omnivorous infants (2-25 mcg/mg [1.7-21.4 mumol/mmol] creatinine). Maternal UMMA and serum vitamin B-12 were negatively correlated (r = -0.700, p = 0.003). Infant UMMA concentrations correlated positively with maternal UMMA concentrations (r = 0.686, p = 0.003) and inversely with maternal serum vitamin B-12 concentrations (r = -0.681, p less than 0.001). In three infants with high UMMA concentrations, vitamin B-12 treatment (oral B-12, vitamin B-12 injection, or a modification of maternal diet within the vegetarian philosophy) led to an abrupt decrease of UMMA.

PMID: 3337042 [PubMed - indexed for MEDLINE]

Nutritional vitamin B12 deficiency in a breast-fed infant of a vegan-diet mother.

• Sklar R.

A 7-month-old male presented with lethargy and failure to thrive. The child was exclusively breast-fed from birth by a mother who was a strict vegetarian. Laboratory data revealed macrocytic anemia and methylmalonic acid in the urine, consistent with vitamin B12 deficient anemia. The patient responded well to supplementation with B12 alone and was developmentally normal by 11 months of age. This study emphasizes the need for assuring maternal dietary adequacy during pregnancy and after birth.

PMID: 3948463 [PubMed - indexed for MEDLINE]

[Health and nutritional status of 'alternatively' fed infants and young children, facts and uncertainties. II. Specific nutritional deficiencies; discussion]

• Dagnelie PC,
• Van Staveren WA,
• Hautvast JG.

This article, which is the second in a series of two articles, discusses available scientific information on the nutritional status of infants and preschool children on alternative diets with regard to calcium, iron, vitamin B12 and D. Some favourable aspects of alternative food habits in such children are also mentioned. Most studies report low intakes of vitamin D and in vegan and macrobiotic children also of calcium and vitamin B12, but it cannot be excluded that some alternative sources of these nutrient may have been missed. Deficiencies have been described for vitamin D and B12 but the evidence is often unconvincing. For example, exposure to sunlight has not been measured in most of the studies on rickets. From the literature available, it would appear that there is a need for longitudinal research on the growth and development of alternatively fed infants and preschool children and for information on the nutrient composition of alternative foods.

PMID: 3913054 [PubMed - indexed for MEDLINE]

Megaloblastic anaemia in a vegetarian Hindu community.

• Chanarin I,
• Malkowska V,
• O'Hea AM,
• Rinsler MG,
• Price AB.

138 Indian patients with megaloblastic haemopoiesis were studied. All were lifelong vegetarians. The diagnosis was nutritional cobalamin deficiency in 95 and pernicious anaemia in 20; only 4 patients had folate deficiency. A third had intestinal malabsorption, 20 had features of osteomalacia, and 87 were iron deficient. Tuberculosis was diagnosed in 17. Cobalamin deficiency may have contributed to these complications via intestinal malabsorption and impaired bacterial killing of phagocytosed bacilli by cobalamin-deficient macrophages. The frequency of pernicious anaemia was the same in Indian subjects as in Caucasians.

PMID: 2865624 [PubMed - indexed for MEDLINE]

Nutrient intake and health status of lactovegetarians: chemical analyses of diets using the duplicate portion sampling technique.

• Abdulla M,
• Aly KO,
• Andersson I,
• Asp NG,
• Birkhed D,
• Denker I,
• Johansson CG,
• Jagerstad M,
• Kolar K,
• Nair BM, et al.

Six middle-aged lactovegetarians (three men and three women) collected copies of four 24-h diets using the duplicate portion sampling technique. By chemical analyses, the nutrient composition of the lactovegetarian diet was determined in detail and compared with that of a mixed Swedish diet (normal) and a vegan diet (vegan) studied previously. The nutrient composition of the lactovegetarian diet expressed per 1000 kcal represented an average between normal and vegan diets. It was in closer agreement with Swedish recommended dietary allowances than the normal Swedish diet. Thus, the lactovegetarian diet contained 35% of the energy as fat and was rich in polyunsaturated fatty acids, especially linoleic acid, which resulted in a polyunsaturated/saturated fat ratio of 0.6. The lactovegetarian diet had a cholesterol concentration only half of that of a normal diet. Protein content and amino acid composition were well above recommendations. The lactovegetarian diets contained less sucrose than normal and vegan diets, but the sum of the intake of low molecular weight carbohydrates was comparable to normal and vegan diets. Dietary fiber was three times higher than in a normal diet. Essential minerals and trace elements, ie, Ca, Mg, Na, K, Fe, Zn, Cu, Se, satisfied current requirements. The intake of vitamin B12 by the lactovegetarians was around 1.4 micrograms daily, which is below the recommendations. The intake of folates was high, 300 to 400 micrograms daily. The clinical and biochemical investigation of the subjects revealed no signs of nutritional deficiency. Their plasma lipoproteins and the blood pressures were low for their age, in agreement with observations made earlier in a group of vegans.

PMID: 6547809 [PubMed - indexed for MEDLINE]

Nutrient intake and health status of vegans. Chemical analyses of diets using the duplicate portion sampling technique.

• Abdulla M,
• Andersson I,
• Asp NG,
• Berthelsen K,
• Birkhed D,
• Dencker I,
• Johansson CG,
• Jagerstad M,
• Kolar K,
• Nair BM,
• Nilsson-Ehle P,
• Norden A,
• Rassner S,
• Akesson B,
• Ockerman PA.

A strict vegetarian diet [vegan diet (VD)] was investigated. Six middle-aged vegans (three men and three women) collected copies of 24-h diets using the duplicate portion sampling technique. By chemical analyses, the nutrient composition was determined in detail and compared with corresponding figures of a normal mixed Swedish diet. In the VD 30% of the energy originated from fat compared with 40% in normal Swedish mixed diet (MD). Linoleic acid was the dominant fatty acid (60% of total fat in VD versus 8% in MD). The VD contained 24 g protein/1000 kcal compared to 30 g/1000 kcal in MD, but the intake of essential amino acids by the vegans exceeded the recommendations. Dietary fiber was about 5 times higher in the vegan diet (29 versus 6 g/1000 kcal) and sucrose similar to MD (18 versus 21 g/1000 kcal). Among the inorganic nutrients the concentration of calcium (351 versus 391 mg/1000 kcal) and sodium (53 versus 49 mmol/1000 kcal) were similar in both types of diets but the amount of potassium (56 versus 30 mmol/1000 kcal, magnesium (300 versus 110 mg/1000 kcal), iron (9 versus 6.5 mg/1000 kcal), zinc (6.5 versus 4.7 mg/1000 kcal), and copper (2 versus 0.7 mg/1000 kcal) were nearly doubled. Iodine (39 versus 156 micrograms/1000 kcal and selenium (5 versus 17 micrograms/1000 kcal) were much lower in the VD, selenium even being undetectable in several 24-h diets. The VD was rich in folic acid (301 versus 90 micrograms/1000 kcal in MD) but the intake of vitamin B12 was only 0.3 to 0.4 microgram/day (MD: 3 to 4 micrograms/day). No clinical signs of nutritional deficiency were observed in the vegans. Serum protein levels of the vegans as well as their serum lipoproteins were near the lower range of the reference group. In addition, none of the vegans was overweight and their blood pressures were low for their age.

PMID: 6272567 [PubMed - indexed for MEDLINE]

Vitamin B12 status on a vegetarian diet. A clinical review.

• Immerman AM.

PMID: 7051580 [PubMed - indexed for MEDLINE]

Long-term clearance of [57Co]cyanocobalamin in vegans and pernicious anaemia.

• Amin S,
• Spinks T,
• Ranicar A,
• Short MD,
• Hoffbrand AV.

1. Whole-body counting has been used to monitor the clearance of [57Co]cyanocobalamin in normal subjects, vegans and patients with pernicious anaemia. After oral administration of 57Co-labelled cyanocobalamin (1 microgram/1 muCi), subjects were counted for radioactivity monthly for a maximum period of 1 year. 2. The results obtained were consistent with a monoexponential clearance model and a least squares fit showed that there was no significant difference between the mean clearance rates for the vegans and normal subjects. 3. The patients with pernicious anaemia cleared the vitamin significantly more quickly than the normal control subjects. 4. This may be due to failure to reabsorb biliary vitamin B12 in pernicious anaemia because of the absence of intrinsic factor.

PMID: 6766367 [PubMed - indexed for MEDLINE]

Brain damage in infancy and dietary vitamin B12 deficiency.

• Wighton MC,
• Manson JI,
• Speed I,
• Robertson E,
• Chapman E.

A case of the exclusively breast-fed infant of a vegetarian mother is reported. Neurological deterioration commenced between three and six months of age, and progressed to a comatose premoribund state by the age of nine months. Investigations revealed a mild nutritional vitamin B12 deficiency in the mother, and a very severe nutritional B12 deficiency in the infant, with severe megaloblastic anaemia. Treatment of the infant with vitamin B12 resulted in a rapid clinical and haematological improvement, but neurological recovery was incomplete. Evidence is presented that dietary B12 deficiency was the sole cause of the infant's deterioration, and the literature relating to the condition is reviewed. It is recommended that all strict vegetarians (vegans), especially women in the child-bearing age group, take vitamin B12 supplements.

PMID: 502936 [PubMed - indexed for MEDLINE]

A syndrome of methylmalonic aciduria, homocystinuria, megaloblastic anemia and neurologic abnormalities in a vitamin B12-deficient breast-fed infant of a strict vegetarian.

• Higginbottom MC,
• Sweetman L,
• Nyhan WL.

We studied a six-month-old infant with severe megaloblastic anemia, coma and hyperpigmentation of the extremities. He was found to have methylmalonic aciduria (79 mumol per milligram of creatinine) and homocystinuria (0.85 mumol per milligram of creatinine). Additional biochemical abnormalities included cystathioninuria, glycinuria, methylcitric aciduria, 3-hydroxypropionic aciduria and formic aciduria. The concentration of vitamin B12 in the serum was 20 pg per milliliter. This severe nutritional deficiency was a consequence of inadequate intake, for the infant was exclusively breast-fed by a strictly vegetarian mother who manifested methylmalonic aciduria. Our observations emphasize the importance of educating strict vegetarians about the deficiency of vitamin B12 in their diets and the importance of vitamin B12 supplementation.

PMID: 683264 [PubMed - indexed for MEDLINE]

Interrelationships between the B-vitamins in B12-deficiency neuromyelopathy. A possible malabsorption-malnutrition syndrome.

• Dastur DK,
• Santhadevi N,
• Quadros EV,
• Gagrat BM,
• Wadia NH,
• Desai MM,
• Singhal BS,
• Bharucha EP.

Five patients presenting clinically with a form B12-deficiency neuromyelopathy, with cord involvement in all and proximal muscle weakness in two of them, were investigated for their neurologic, hematologic and vitamin status. Megaloblastosis and achlorhydria were present in all, and impaired absorption of 57Co vitamin B12 and of D-xylose was detected in four. Total cyanide extracted vitamin B12 (A) was lowered in all cases and noncyanide extractable (B) in four of the five, being zero in three. All five responded to injections of hydroxocobalamin. In two patients sequential estimations showed that both A and B, especially the latter, rose steeply initially, normalizing at 50% of A after some weeks. Moiety B is suggested to be physiologically the more active and dissociable form of vitamin B12. Markedly elevated initial serum folate levels, and their subsequent fall under treatment with B12, indicated the operation of the "methyltetrahydrofolate trap". Blood levels of thiamin, nicotinic acid and pantothenic acid were within normal limits. However, serum riboflavin (B2) total vitamin B6 and pyridoxal were reduced in all where tested. Vitamin B6 deficiency could have resulted from its own malabsorption and have contributed to be B12 deficiency. Vitamin B2 and B6 levels also corrected themselves on B12 therapy. The B-vitamin deficiencies in our patients probably resulted from intestinal malabsorption, with a possible factor of malnutrition consequent to their strictly vegetarian diet.

PMID: 1242617 [PubMed - indexed for MEDLINE]

Vegetarian diets.

• Sutnick MR.

A growing number of Americans are choosing to follow vegetarian diets. These diets can meet the nutritional needs of individuals of all ages. Vegetarians who eat eggs and/or milk and dairy products have no special problems in obtaining adequate nutrients. Pure vegetarians, who avoid all animal products, should pay particular attention to sources of protein, calcium, and riboflavin. Supplementation of vitamin B12 is indicated in these individuals. Guidelines for both good normal nutrition and therapeutic diets can be adapted for use with a vegetarian diet.

PMID: 1046253 [PubMed - indexed for MEDLINE]

Vitamin B12 nutrition and metabolism in the baboon (Papio cynocephalus).

• Siddons RC,
• Jacob F.

1. Measurement of the vitamin B12 content of baboon tissues showed that the liver contained the highest concentration, followed by the pituitary, kidney, heart, spleen and pancreas. 2. The dietary vitamin B12 requirement of the baboon for the maintenance of satisfactory body stores was between 1 and 2 mug/d. 3. Satisfactory liver vitamin B12 stores were invariably associated with serum levels above 125 pg/ml, whereas liver levels were usually low when the serum level was below 50 pg/ml. 4. Increased methylmalonic acid (MMA) excretion after a valine load occurred when the liver vitamin B12 level was less than 0-40 mug/g. L- and DL-valine were approximately equally effective as precursors of MMA, whereas sodium propionate, whether given orally or intraperitoneally, was less effective. 5. The distribution of radioactivity along the wall of the intestinal tract after an oral dose of [57-Co]cyanocobalamin suggested that the distal half of the small intestine was the main site of vitamin B12 absorption. However, the utilization of vitamin B12 put direct into the middle part of the small intestine was much lower than that of an oral dose. 6. The unsaturated vitamin B12-binding capacity of baboon serum was not related to the serum vitamin B12 level. There was a significant difference between the unsaturated vitamin B12-binding capacities of the two subspecies of baboon (Papio cynocephalus cynocephalus and P. cynocephalus anubis) studied.

PMID: 1125171 [PubMed - indexed for MEDLINE]

Vitamin B12 and vegetarianism in india.

• Jathar VS,
• Inamdar-Deshmukh AB,
• Rege DV,
• Satoskar RS.

Apparently healthy Indian lactovegetarians have significantly lower serum levels and urinary excretion of vitamin B12 as compared to non-vegetarians. The low levels of serum vitamin B12 in lactovegetarians are not due to defective absorption but to low dietary intake of this vitamin. Inspite of considerably low serum vitamin B12 values, the lactovegetarians have no apparent signs or symptoms of vitamin B12 deficiency and their response to injected cyanocobalamin mixed with tracer radioactive B12, as judged by urinary excretion pattern and liver uptake, was similar to that observed in nonvegetarians.

PMID: 804798 [PubMed - indexed for MEDLINE]

Hematological, vitamin B 12, and folate studies on Seventh-day Adventist vegetarians.

• Armstrong BK,
• Davis RE,
• Nicol DJ,
• van Merwyk AJ,
• Larwood CJ.

PMID: 4424826 [PubMed - indexed for MEDLINE]

Blood and neoplastic diseases: megaloblastic anaemia.

• Hoffbrand AV,
• Lavoie A.

PMID: 4407128 [PubMed - indexed for MEDLINE]

Megaloblastic anaemia among Indians in Britain.

• Britt RP,
• Harper C,
• Spray GH.

PMID: 5157407 [PubMed - indexed for MEDLINE]

Chromatographic and bioautographic estimation of plasma cobalamins in various disturbances of vitamin B12 metabolism.

• Linnell JC,
• Hoffbrand AV,
• Peters TJ,
• Matthews DM.

PMID: 5539299 [PubMed - indexed for MEDLINE]

Serum vitamin B 12 levels in Indian psychiatric patients.

• Jathar VS,
• Patrawalla SP,
• Doongaji DR,
• Rege DV,
• Satoskar RS.

PMID: 5492181 [PubMed - indexed for MEDLINE]

Response of dietary vitamin-B12 deficiency to physiological oral doses of cyanocobalamin.

• Stewart JS,
• Roberts PD,
• Hoffbrand AV.

PMID: 4195205 [PubMed - indexed for MEDLINE]

Degeneration in the peripheral visual pathway of vitamin B12-deficient monkeys.

• Hind VM.

PMID: 4997474 [PubMed - indexed for MEDLINE]

Nutritional vitamin B12 deficiency in an infant.

• Lampkin BC,
• Saunders EF.

PMID: 5352832 [PubMed - indexed for MEDLINE]

Patterns of plasma cobalamins in control subjects and in cases of vitamin B12 deficiency.

• Linnell JC,
• Mackenzie HM,
• Wilson J,
• Matthews DM.

PMID: 5364437 [PubMed - indexed for MEDLINE]

Gastric and hematological abnormalities in a vegan with nutritional vitamin B 12 deficiency: effect of oral vitamin B 12.

• Winawer SJ,
• Streiff RR,
• Zamcheck N.

PMID: 6027227 [PubMed - indexed for MEDLINE]

The electroencephalogram in veganism, vegetarianism, vitamin B12 deficiency, and in controls.

• West ED,
• Ellis FR.

PMID: 5332786 [PubMed - indexed for MEDLINE]