Vitamin B12 Supplementation and NT-proBNP Levels in COPD Patients: A Secondary Analysis of a Randomized and Controlled Study in Rehabilitation

Abstract

Purpose There is evidence of complex interaction between vitamin B 12 (vB 12 ) level, hyperhomocysteinemia (HyCy), and natriuretic peptide secretion. Exercise training could also modulate such interaction. In this secondary analysis of a Randomized Clinical Trial performed in a chronic obstructive pulmonary disease (COPD) rehabilitation setting, our primary objective was to investigate the interaction between vB 12 supplementation, exercise training, and changes in NT-proBNP levels after 8 weeks of intervention. Secondary objectives were to explore the correlations between acute changes in NT-proBNP levels with (i) acute exercise and (ii) oxygen uptake ( V ’O 2 ) kinetics during rest-to-exercise transition. Methods Thirty-two subjects with COPD were randomized into four groups: Rehabilitation+vB 12 ( n = 8), Rehabilitation ( n = 8), vB 12 ( n = 8), or Maltodextrin( n = 8). They were evaluated at baseline and after 8 weeks, during resting and immediately after maximal exercise constant work-rate tests (CWTs, T lim), for NT-proBNP plasmatic levels. Results After interaction analysis, the supplementation with vB 12 significantly changed the time course of NT-proBNP responses during treatment ( p = 0.048). However, the final analysis could not support a significant change in NT-proBNP levels owing to high-intensity constant work-rate exercise ( p -value > 0.05). There was a statistically significant correlation between V ’O 2 time constant and ΔNT-proBNP values ( T lim – rest) at baseline ( p = 0.049) and 2 months later ( p = 0.015), considering all subjects ( n = 32). Conclusion We conclude that vB 12 supplementation could modulate NT-proBNP secretion. Moreover, possibly, the slower the initial V ’O 2 adjustments toward a steady-state during rest-to-exercise transitions, the more severe the ventricular chamber volume/pressure stress recruitment, expressed through higher NT-proBNP secretion in subjects with larger V ’O 2 time constants, despite unchanged final acute exercise-induced neurohormone secretion.

The Effectiveness of Supplementation with Key Vitamins, Minerals, Antioxidants and Specific Nutritional Supplements in COPD—A Review

“…Another study investigated the effect of vitamin B 12 supplementation on exercise and natriuretic peptide levels after an 8-week intervention. The results showed that vitamin B 12 supplementation significantly altered the temporal secretion of NT-proBNP (natriuretic peptide) during treatment ( p = 0.048), suggesting that vitamin B 12 supplementation should be considered for COPD patients due to the increased risk of cardiovascular morbidity [ 36 ].…”

Editorial: Cardiorespiratory Coupling-Novel Insights for Integrative Biomedicine

“…The relationship between neural autonomic and humoral factors seems to be particularly important during rehabilitation of patients with chronic obstructive pulmonary disease (COPD): (Paulin et al, 2020 ) in a secondary analysis of a previous randomized trial (Paulin et al, 2017 ) point out for the first time for the relevance of Vitamin B12 on cardiovascular health in COPD subjects. Supplementation with vitamin B12 appears to lead to discrete positive effects on exercise tolerance in groups of subjects with more advanced COPD, significantly changing the time course of NT-proBNP responses during treatment.…”