Systematic Review on Daily Vitamin B12 Losses and Bioavailability for Deriving Recommendations on Vitamin B12 Intake with the Factorial Approach

Doets, Esmée L.; Veld, Paulette H In 't; Szczecinska, A.; Dhonukshe-Rutten, R.A.M.; Cavelaars, Adriënne E J M; Veer, P. van ‘t; Brzozowska, Anna; Groot, Lisette C. P. G. M. de

doi:10.1159/000346968

Cited by 61 publications

(59 citation statements)

References 91 publications

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“…The Panel notes that the regression equation by Doets et al (2013a) is based on cobalamin absorption measures from varying foods and doses in small numbers of subjects, which limit the robustness of the relationship derived from these data. At a given dose level, fractional absorption has been observed to be rather variable and may depend on the dietary source and other factors.…”

Section: Intestinal Absorptionmentioning

confidence: 99%

“…In a systematic review, publications reporting daily cobalamin losses were collected (Doets et al, 2013a), including a pooled analysis of five studies measuring cobalamin losses with whole-body counting (Bozian et al, 1963;Heyssel et al, 1966;Reizenstein et al, 1966;Adams and Boddy, 1968;Boddy and Adams, 1968). Data were available from 52 subjects, comprising healthy subjects and patients with or without pernicious anaemia or "low cobalamin status".…”

Section: Eliminationmentioning

confidence: 99%

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Scientific Opinion on Dietary Reference Values for cobalamin (vitamin B12)

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2015

EFS2

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Following a request from the European Commission, the EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA) derived Dietary Reference Values (DRVs) for cobalamin (vitamin B12). The Panel considers that the approach based on a combination of biomarkers of cobalamin status, i.e. serum cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA) and plasma total homocysteine (tHcy), is the most suitable approach to derive DRVs for cobalamin. The Panel notes the uncertainties with respect to cut-off values for cobalamin insufficiency of these indicators and that an Average Requirement (AR) cannot be determined from the limited data available. There is consistent evidence in adults that a cobalamin intake of 4 µg/day and greater is associated with serum concentrations of holoTC and cobalamin within the reference ranges derived from healthy subjects, together with MMA and tHcy concentrations below the cut-off values for adults, which indicates an adequate cobalamin status. Therefore, the Panel sets an Adequate Intake (AI) for cobalamin at 4 µg/day for adults based on data on different biomarkers of cobalamin status and in consideration of observed mean intakes, which range between 4.2 and 8.6 μg/day in adults in several EU countries. AIs for infants and children are calculated by extrapolation from the AI for adults using allometric scaling and applying a growth factor. Estimated AIs range from 1.5 µg/day in infants aged 7-11 months to 4 µg/day in children aged 15-17 years. For pregnancy and lactation, additional cobalamin intakes related to the accumulation of cobalamin in fetal tissues and transfer of cobalamin into breast milk are considered and AIs of 4.5 and 5 µg/day, respectively, are proposed. Cobalamin is a metal complex with a central cobalt atom bonded to six ligands. The upper or β-axial ligand varies (R-group: cyano-, hydroxo-, aquo-, methyl-or adenosyl-group), giving rise to the correspondingly named chemical forms of the vitamin. In humans, two reactions are known to require cobalamin as coenzyme. One is the rearrangement of methylmalonyl-coenzyme A (CoA) to succinylCoA in propionate metabolism by methylmalonyl-CoA mutase in mitochondria. The other is the cytosolic transmethylation of homocysteine by 5-methyl-tetrahydrofolate to methionine by methionine synthase. The most frequent clinical expression of cobalamin deficiency is megaloblastic anaemia. Independent of megaloblastic anaemia, neurological dysfunction is another clinical feature of cobalamin deficiency. Cobalamin insufficiency is characterised by biochemical abnormalities, such as elevated total homocysteine (tHcy) and/or methylmalonic acid (MMA) concentrations in blood resulting from impaired cobalamin metabolic activity, with no specific clinical symptoms. © EuropeanCobalamin absorption consists of several steps, including its release from proteins, its binding by gastric intrinsic factor and the absorption of intrinsic factor-cobalamin complexes through receptormediated endocytosis in the terminal ileum. Fractional absor...

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Section: Intestinal Absorptionmentioning

confidence: 99%

Section: Eliminationmentioning

confidence: 99%

Scientific Opinion on Dietary Reference Values for cobalamin (vitamin B12)

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2015

EFS2

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“…As yet there is no evidence that vitamin B 12 is handled differently in old age once the vitamin is absorbed. Therefore, other factors responsible for the cobalamin deficiency need to be sought (21) .There is a large body of evidence to indicate that malnutrition is a common problem in older adults. Estimates of the prevalence are undeniably high: up to 60 % of hospitalised elderly and 70 % of those in residential care are malnourished.…”

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confidence: 99%

Nutritional issues for older adults: addressing degenerative ageing with long-term studies

Groot

2016

Proc. Nutr. Soc.

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The ageing process is influenced by a variety of factors, including extrinsic, malleable lifestyle variables. The present paper deals with the epidemiological evidence for the role of dietary patterns and key nutritional concerns in relation to survival and ageing-related disorders that present themselves in later life. Healthful dietary patterns appear to be most relevant in old age. Specific nutritional concerns are related to vitamin D, vitamin B 12 and protein malnutrition. An important challenge to further expand the knowledge base is currently addressed by the NuAge project, acknowledging the complexity of the ageing process and integrating different dimensions of research into human healthy ageing. In the meantime, reversing poor adherence to existing guidelines for a healthy diet remains a first challenge in public health nutritional practices.Nutrition: Aged: Health: Survival Ageing and nutritionMany industrialised countries now have ageing populations. In EU-27, the proportion of Europeans over the age of 65 is projected to increase from 17·4 % (2011) to approximately 30 % by 2060 (1) . Even though most people reach old age in reasonable health, they are facing potential consequences of the ageing process. Ageing occurs through the lifelong accumulation of subtle faults in cells and tissues resulting in progressive loss of function, frailty and disease (2) . Common features such as a mild chronic pro-inflammatory status, or inflammageing (3) , are implicated in several ageing-related pathologies such as osteoporosis, dementia and sarcopenia and may become major disabling conditions (4) . As yet, there is substantial mechanistic evidence that it is possible to impact on the interplay between intrinsic factors and nutrition (5) . Moreover, in the past decades many epidemiological studies have uncovered a significant role of diet quality in the prevention of chronic disease and mortality later in life, whereby nutrition intervention studies have demonstrated benefits for dietary patterns and specific nutrients. The present paper aims to address the epidemiological evidence for the role of dietary patterns and key nutritional concerns in relation to survival and ageing-related disorders that present themselves later in life. In the meantime Nu-Age, an European Commission-funded project, is holistically interrogating the link between diet and ageing in order to define new dietary strategies addressing the specific needs of older adults (6) . Dietary patterns and survivalThe dietary intake of foods and nutrients are related, and, as people do not eat single nutrients or foods, evaluating dietary patterns has attracted considerable interest in nutritional epidemiology. Assessing dietary quality by dietary patterns has the advantage of capturing the high inter-correlation of nutrients within a diet, as well as integrating complex interactive effects of many dietary exposures (7) . This follows from several systematic reviews of prospective studies relating adherence to a healthful diet to survival or increased...

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“…The need for an appropriate cut-off is shared with currently used NIVs, e.g., deriving the ANR based on the balance method used in France and The Netherlands critically depends on assumptions on liver stores necessary to maintain health [32]. Vitamin B-12 requirements set by IOM are based on achieving stable haemoglobin, normal mean cell volume and normal reticulocyte response as the health endpoints.…”

Section: Discussionmentioning

confidence: 99%

A Statistical Method to Base Nutrient Recommendations on Meta-Analysis of Intake and Health-Related Status Biomarkers

et al. 2014

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Nutrient recommendations in use today are often derived from relatively old data of few studies with few individuals. However, for many nutrients, including vitamin B-12, extensive data have now become available from both observational studies and randomized controlled trials, addressing the relation between intake and health-related status biomarkers. The purpose of this article is to provide new methodology for dietary planning based on dose-response data and meta-analysis. The methodology builds on existing work, and is consistent with current methodology and measurement error models for dietary assessment. The detailed purposes of this paper are twofold. Firstly, to define a Population Nutrient Level (PNL) for dietary planning in groups. Secondly, to show how data from different sources can be combined in an extended meta-analysis of intake-status datasets for estimating PNL as well as other nutrient intake values, such as the Average Nutrient Requirement (ANR) and the Individual Nutrient Level (INL). For this, a computational method is presented for comparing a bivariate lognormal distribution to a health criterion value. Procedures to meta-analyse available data in different ways are described. Example calculations on vitamin B-12 requirements were made for four models, assuming different ways of estimating the dose-response relation, and different values of the health criterion. Resulting estimates of ANRs and less so for INLs were found to be sensitive to model assumptions, whereas estimates of PNLs were much less sensitive to these assumptions as they were closer to the average nutrient intake in the available data.

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Systematic Review on Daily Vitamin B12 Losses and Bioavailability for Deriving Recommendations on Vitamin B12 Intake with the Factorial Approach

Cited by 61 publications

References 91 publications

Scientific Opinion on Dietary Reference Values for cobalamin (vitamin B12)

Scientific Opinion on Dietary Reference Values for cobalamin (vitamin B12)

Nutritional issues for older adults: addressing degenerative ageing with long-term studies

A Statistical Method to Base Nutrient Recommendations on Meta-Analysis of Intake and Health-Related Status Biomarkers

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