Vitamin B12, homocysteine and carotid plaque in the era of folic acid fortification of enriched cereal grain products

Robertson, Julie; Iemolo, Francesco; Stabler, Sally P.; Allen, Robert H.; Spence, J. David

doi:10.1503/cmaj.045055

Cited by 64 publications

(52 citation statements)

References 23 publications

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“…Moreover, Robertson has reported that vitamin B12 deficiency is common in patients with vascular diseases [25] , and folate and vitamin B12 supplements can decrease the risk of ischemic cerebral disease [26] . Vitamin B12 deficiency is also involved in the development and progression of dementia [27] .…”

Section: Discussionmentioning

confidence: 99%

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

et al. 2009

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Objective To investigate the status of vitamin B12 deficiency in elderly inpatients in the department of neurology.Methods A total number of 827 patients in the department of neurology of Shanghai Punan hospital, from March 2007 to July 2008, were employed in the present study. They were 60 years or older, and the average age was 77.1±7.5 years old. All the patients were diagnosed with no severe hepatic or renal dysfunction, without any usage of vitamin B12 during the previous 3 months before the detection. The levels of serum vitamin B12, folate and homocysteine (Hcy) were evaluated. The patients with vitamin B12 deficiency were screened. The resulting symptoms, positive signs of neurological examination, and the neuroelectricphysiological results were compared between patients with or without vitamin B12 deficiency. Results Vitamin B12 deficiency was found in 163 patients (19.71% of the total patients), and was more prevalent in female than in male patients, also with increased incidences with aging. Patients with low levels of serum vitamin B12 exhibited higher rate of gastrointestinal diseases, while only 9.82% of the vitamin B12 deficient patients had megaloblastic anemia. Symptoms of vitamin B12 deficiency included unsteadily walking in the darkness and hypopallesthesia, and some chronic diseases such as cerebral ischemia, hypertension, Parkinson's disease (Parkinsonism), diabetes mellitus and coronary heart disease. Most of the vitamin B12 deficient patients had neuroelectricphysiological abnormalities. Conclusion Vitamin B12 deficiency is remarkably common in elderly patients in neurology department, with various and atypical clinical manifestations, and the neurological symptoms are more common than megaloblastic anemia symptoms.

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Section: Discussionmentioning

confidence: 99%

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

et al. 2009

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“…We reviewed serum vitamin B-12 concentrations to determine the sufficiency using cutoff values of ,148 pmol/L (21-24), 200 pmol/L (25)(26)(27), and 258 pmol/L (7,28,29). We also used vitamin B-12 status based on the cutoffs that Stabler et al (30) originally proposed and that we modified for this analysis.…”

Section: Biochemical Methodsmentioning

confidence: 99%

Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12

Bailey¹,

Carmel²,

Green³

et al. 2011

The American Journal of Clinical Nutrition

136

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Background: Various definitions, criteria, tests, and cutoffs have been used to define vitamin B-12 status; however, a need exists for the systematic study of vitamin B-12 status in the United States because of concerns about high folic acid intakes and the potential for associated adverse effects. Objective: The objective was to determine the effect of different cutoff choices on outcomes and of the different degrees of serum vitamin B-12 status, definable by the concurrent use of a functional and circulating marker as the first steps to developing a data-based consensus on the biochemical diagnosis of vitamin B-12 deficiency. Design: Data from NHANES, a nationally representative crosssectional survey, were examined for adults aged .19 y (mean 6 SD age: 45 6 1 y) from 1999 to 2004 (n = 12,612). Results: Commonly used cutoffs had a greater effect on prevalence estimates of low vitamin B-12 status with the use of vitamin B-12 than with the use of methylmalonic acid (MMA; 3-26% and 2-6%, respectively). A cutoff of .148 pmol/L for vitamin B-12 and of 210 nmol/L for MMA resulted in significant misclassifications. Approximately 1% of adults had a clear vitamin B-12 deficiency (low vitamin B-12 and elevated MMA); 92% of adults had adequate vitamin B-12 status. A high percentage of younger women characterized the group with low vitamin B-12 and normal MMA (2% of adults) and may have falsely reflected low vitamin B-12. Adults with elevated MMA (5%) only were demographically similar (ie, by age and race) to the deficient group and may have included some individuals with early vitamin B-12 deficiency. Conclusions: These analyses indicate the challenges of assessing vitamin B-12 status when uncertainties exist about the appropriate cutoffs. Future studies should determine definable endpoints to achieve this goal.Am J Clin Nutr 2011;94:552-61.

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“…33 It is present in 20 % of the elderly, 34 so the 'normal' range (the 95 % of the population within two standard deviations of the mean) includes, in the elderly, quite a few people with B12 deficiency (about 17.5 % of those in the normal range).…”

Section: Metabolic B12 Deficiencymentioning

confidence: 99%

“…B12 deficiency raises levels of homocysteine, 33 which is a clotting factor that increases the risk for deep vein thrombosis, retinal vein thrombosis and cerebral vein thrombosis, and quadruples the risk for stroke in patients with atrial fibrillation. 38 This is probably why reduction of homocysteine is important in stroke prevention, even though it has not reduced myocardial infarction.…”

Section: Metabolic B12 Deficiencymentioning

confidence: 99%

Nutrition in Stroke Prevention

Spence¹

2013

US Neurology

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45The importance of nutrition to stroke prevention is vastly under-appreciated.Many physicians and patients think that if they are taking a statin, they can eat whatever they want. Few concepts could be further from the truth. An AbstractNutrition is far more important than most physicians and patients recognize. Maintaining a healthy weight, reducing dietary cholesterol, avoiding egg yolks, and consuming a Cretan Mediterranean diet substantially reduce the risk for stroke. Besides the very high cholesterol content of egg yolks (more than the recommended daily intake of 200 mg of cholesterol in a single large egg yolk), it is now apparent that phosphatidylcholine (lecithin, 250 mg per egg yolk) is converted by intestinal bacteria to trimethylamine, which in turn is oxidized in the liver to trimethylamine n-oxide (TMAO), which is pro-atherosclerotic in animal models and increases the risk for cardiovascular events in patients at risk for coronary disease. Unrecognized metabolic deficiency of vitamin B12 is very common, and frequently missed, because a 'normal' serum B12 is not a reliable test for adequacy of B12. Besides neuropathy, myelopathy, and dementia, B12 deficiency increases the risk for stroke by raising levels of total homocysteine (tHcy). Despite widespread misunderstanding of the complex issues, it is increasingly clear that B vitamin therapy to reduce homocysteine does reduce the risk for stroke. However adequacy of B12 dosing and renal impairment determine the response to B vitamin therapy: cyanocobalamin is beneficial in patients with normal kidney function, but harmful in those with renal impairment (GFR<50). Methylcobalamin should be used in patients with renal impairment. KeywordsNutrition, diet, cholesterol, egg yolk, homocysteine, vitamin B12 Western Road, London, ON, Canada N6G 2V2. E: dspence@robarts.ca total homocysteine (tHcy) increase the risk for stroke, and B vitamin supplementation to reduce the risk for stroke. Maintaining a Healthy WeightThe high intake of fat and carbohydrates that lead to obesity increase the risk for diabetes and of vascular disease through effects independent of obesity per se. However, obesity is an independent risk factor for stroke. 3,4,5 Although heredity undoubtedly plays an important role in obesity, 'genes are not destiny'. People with an inherited tendency to obesity may need to maintain a lower caloric intake and/or a higher level of activity to maintain a healthy weight. The arithmetic of weight maintenance is simple (and simpler with imperial units than with metric units): to maintain a given weight, the average caloric intake is approximately 10 calories (kilocalories) per pound. Assuming a normal level of (in)activity for sedentary office workers, a person who weighs 250 pounds has been consuming approximately 2,500 calories per day. One pound of fat represents 3,500 stored calories and a mile of walking only burns off 100 calories. Thus to lose a pound, one would need to walk 35 miles, or reduce caloric intake by 500 calories per day for a week. (I...

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Vitamin B12, homocysteine and carotid plaque in the era of folic acid fortification of enriched cereal grain products

Cited by 64 publications

References 23 publications

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

An investigation of vitamin B12 deficiency in elderly inpatients in neurology department

Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12

Nutrition in Stroke Prevention

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