Efficacy and Safety of Fortification and Supplementation with Vitamin B<sub>12</sub>: Biochemical and Physiological Effects

Carmel, Ralph

doi:10.1177/15648265080292s121

Cited by 59 publications

(50 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The pathophysiology of cobalamin differs in important ways from most other vitamins, such as folate. 25 The daily requirement is so small relative to stores ( Table 1) that deficiency typically takes years to develop in adults and only infrequently reaches the depletion point necessary for clinical consequences. Cobalamin is also tightly chaperoned everywhere by specific binding proteins and receptors that regulate how much traverses gut and other cell membranes, how much is reabsorbed after biliary secretion, and how much is retained by the body.…”

Section: Finding the Cause Of The Cobalamin Deficiencymentioning

confidence: 99%

See 1 more Smart Citation

How I treat cobalamin (vitamin B12) deficiency

Carmel

2008

Blood

Self Cite

274

223

View full text Add to dashboard Cite

The challenges in medical management of cobalamin deficiency lie in attention to the unique pathophysiology that underlies cobalamin deficiency, more than in the mechanics of therapy. The central physiologic principles are that clinically important deficiency is more likely to occur (and progress) when intrinsic factor-driven absorption fails than when diet is poor and that most causes take years to produce clinically obvious deficiency. Transient defects have little clinical impact. The key management principle is the importance of follow-up, which also requires knowing how the deficiency arose. The virtues of these principles are not always fully appreciated. Recent developments have made diagnosis and management more difficult by diminishing the ability to determine cobalamin absorption status. Clinicians must also grapple with premature medicalization of isolated, mild biochemical changes that added many asymptomatic cases of still undetermined medical relevance to their caseload, often expanded by inflated cobalamin level criteria. The potential for misattribution of cobalamin-unrelated presentations to nongermane cobalamin and metabolite abnormalities has grown. Pathophysiologically based management requires systematic attention to each of its individual components: correctly diagnosing cobalamin deficiency, reversing it, defining its underlying cause, preventing relapse, managing the underlying disorder and its complications, and educating the patient. (Blood. 2008;112: 2214-2221)

show abstract

Section: Finding the Cause Of The Cobalamin Deficiencymentioning

confidence: 99%

“…Without very well-designed trials, routine cobalamin supplementation for the elderly has unknown value, even in the era of folic acid fortification. 25 Unnecessary folate supplements should be discouraged. Cobalamin status should be evaluated proactively in special situations.…”

Section: Cobalamin Prophylaxis In Clinical Practicementioning

confidence: 99%

How I treat cobalamin (vitamin B12) deficiency

Carmel

2008

Blood

Self Cite

274

223

View full text Add to dashboard Cite

show abstract

“…Several studies conducted in low-and middleincome countries also have reported a high prevalence of vitamin B-12 deficiency, particularly in pregnant women and young children (6), in part due to inadequate dietary vitamin B-12 intake (7,8), increased requirements during pregnancy and lactation, and low vitamin B-12 content and bioavailability in breast milk (9). Micronutrient supplementation is a common strategy to prevent and treat cobalamin deficiency (10), and there is emerging interest in mandatory food fortification with vitamin B-12 (11).…”

Section: Introductionmentioning

confidence: 99%

Vitamin B-12 and Cognition in Children

Venkatramanan¹,

Armata²,

Strupp

et al. 2016

Advances in Nutrition

View full text Add to dashboard Cite

Vitamin B-12 is essential for brain development, neural myelination, and cognitive function. Inadequate vitamin B-12 status during pregnancy and early childhood has been associated with adverse child health outcomes, including impaired cognitive development. However, the underlying mechanisms have not been elucidated. This review was conducted to examine the evidence that links vitamin B-12 and cognition in children. The search strategy resulted in 17 studies: 3 cross-sectional, 1 case-control, and 12 cohort studies, and 1 randomized trial. Cognitive processes assessed included attention, memory, and perception. Developmental outcomes, academic performance, and intelligence quotient were also considered. Despite the high prevalence of vitamin B-12 insufficiency and associated risk of adverse cognitive outcomes in children, to our knowledge, no studies to date have been conducted to examine the effects of vitamin B-12 supplementation on cognition in children. The role of vitamin B-12 in the etiology of child cognitive outcomes needs to be elucidated to inform public health interventions. Adv Nutr 2016;7:879-88.

show abstract

“…Geriatric studies reporting good responses to small oral doses usually apply broad statistical brushes that obscure the small but critical subsets at risk that populate the margins. In fact, much evidence, summarized elsewhere [65,69] and reconfirmed recently [70 & ], shows that many elderly persons with SCCD require surprisingly high cobalamin doses. All successful clinical trials of cognitive benefits used 500-1000 mg doses, which are unwieldy for fortification, combined with substantial doses of folic acid and pyridoxine.…”

Section: Cobalamin Supplementation and Fortificationmentioning

confidence: 92%

“…Advocates cite folic acid as their fortification model. However, as reviewed elsewhere [65], folic acid fortification succeeded because folate physiology guaranteed sufficient bioavailability, and research proved efficacy and health benefits beforehand. None of these are true for cobalamin fortification currently; the benefits await confirmation and efficacy is suspect.…”

Section: Cobalamin Supplementation and Fortificationmentioning

confidence: 98%

Subclinical cobalamin deficiency

Carmel

2012

Current Opinion in Gastroenterology

Self Cite

View full text Add to dashboard Cite

The story of SCCD, which is severalfold times more common in the elderly than clinical cobalamin deficiency but also differs from it in arising only infrequently from severe malabsorption and thus being less likely to progress, continues to evolve. Preventive benefits need to be confirmed and expanded, and will require fuller understanding of SCCD pathophysiology, natural history, and health consequences.

show abstract

Efficacy and Safety of Fortification and Supplementation with Vitamin B₁₂: Biochemical and Physiological Effects

Abstract: Long known as an uncommon but serious medical disorder requiring medical management, vitamin B 12 deficiency is now seen to be common worldwide, but

Cited by 59 publications

References 41 publications

How I treat cobalamin (vitamin B12) deficiency

How I treat cobalamin (vitamin B12) deficiency

Vitamin B-12 and Cognition in Children

Subclinical cobalamin deficiency

Contact Info

Product

Resources

About

Efficacy and Safety of Fortification and Supplementation with Vitamin B12: Biochemical and Physiological Effects

Abstract: Long known as an uncommon but serious medical disorder requiring medical management, vitamin B 12 deficiency is now seen to be common worldwide, but

Cited by 59 publications

References 41 publications

How I treat cobalamin (vitamin B12) deficiency

How I treat cobalamin (vitamin B12) deficiency

Vitamin B-12 and Cognition in Children

Subclinical cobalamin deficiency

Contact Info

Product

Resources

About

Efficacy and Safety of Fortification and Supplementation with Vitamin B₁₂: Biochemical and Physiological Effects