Impacto nutricional da cirurgia bariátrica: estudo comparativo do Bypass gástrico em Y de Roux e do Sleeve entre pacientes dos sistemas público e privado de saúde / Nutritional impact of bariatric surgery: a comparative study of Roux-en-Y Gastric Bypass and Sleeve gastrectomy between patients from the public and private health systems

RESUMO Objetivos: Comparar a evolução do perfil nutricional de pacientes submetidos ao bypass gástrico em Y de Roux (BGYR) e ao Sleeve, em hospitais dos setores público e privado da Saúde de Pernambuco. Método: O estudo incluiu pacientes submetidos à cirurgia bariátrica nos setores público e privado de saúde de Pernambuco no período de 2008 a 2016. Foram avaliados dados antropométricos e bioquímicos (Hemoglobina, Vitamina B12, Ferro e Ferritina) no período pré-operatório e com 3, 6 e 12 meses de pós-operatório. Resultados: Não foram registradas diferenças significativas entre os pacientes internados nos dois setores da Saúde no tocante às variáveis: níveis hemoglobina, anemia por deficiência de ferro e vitamina B12 em nenhuma das avaliações e conforme o tipo de cirurgia. Entre os pacientes submetidos ao BGYR, os níveis de ferro sérico foram significativamente menores nos pacientes do setor privado da Saúde apenas na primeira avaliação. Baixos níveis de ferritina sérica foram observados na segunda avaliação, sendo os pacientes do setor privado os que apresentaram menores valores. O sucesso cirúrgico foi significativamente maior no grupo que realizou o BGYR na rede privada. Conclusões: Com um seguimento de 12 meses pós-cirurgia bariátrica, não foi observada diferença estatisticamente significante no que diz respeito às deficiências de micronutrientes entre pacientes usuários dos setores público e privado de Saúde.

ABSTRACT Purpose: To compare the nutritional status follow up of patients who underwent Roux-en-Y gastric bypass (BGYR) and Sleeve gastrectomy (SG) in hospitals of the private and public health systems, in Pernambuco. Methods: This study included patients who underwent bariatric surgery in the public and private health systems, in Pernambuco, from 2008 to 2016. Anthropometric and biochemical (hemoglobin, B12, iron and ferritin) data were evaluated in the preoperative period and at 3, 6 and 12 months after the operation. Results: There were no significant difference between patients seen at the two health systems regarding the levels of hemoglobin, iron, anemia and vitamin B12. Patients who underwent the RYGB, presented with iron deficiency which was significantly lower for those in the private system, but only at the 3 month evaluation. Low levels of ferritin were observed at the 6 month evaluation, and patients in the private health system presented with the highest ferritin deficiency. The rate of surgical success was significantly higher in those patients undergoing the RYGB at the private system. Conclusions: After a 12-month bariatric surgery follow-up, there was no statistically significant difference regarding micronutrient deficiency between patients followed up at the private and public health systems.

Hipervitaminosis B12: Nuestra experiencia y una revisión / Hypervitaminosis B12. Our experience and a review

Los altos niveles de vitamina B12 o cobalamina, también denominado hipervitaminosis B12 es una anormalidad analítica frecuentemente subestimada. De acuerdo con la literatura algunas de las entidades relacionadas con este hallazgo son las neoplasias sólidas (primarias o metastásicas) y las enfermedades hematológicas agudas o crónicas. Otras causas incluyen la afección hepática, la gammapatía monoclonal de significación indeterminada, la insuficiencia renal y, con menor frecuencia, un exceso de consumo de vitamina B12, enfermedades inflamatorias o autoinmunes y los trastornos hematológicos transitorios (neutrofilia y eosinofilia secundaria). Este artículo informa sobre causas de hipervitaminosis B12, nuestra experiencia y hace una revisión de la literatura.

High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.

Evaluation of nutritional status in children with amblyopia / Avaliação do estado nutricional de crianças com ambliopia

ABSTRACT Purpose: We aimed to compare the body mass index and vitamin and mineral status of children with and without amblyopia. Methods: Amblyopic children aged between 5 and 18 years (n=46) and age-matched control children (n=32) were evaluated in terms of anthropometric parameters, including height, weight, body mass index and demographic features. Serum vitamin B12 and folate were measured using an Advia Centaur XP (Siemens, Ireland) biochemistry analyzer. We evaluated the inorganic mineral elements from hair samples with inductively coupled plasma-mass spectrometry using a Thermo XSeries 2 analyzer (Thermo Fisher Scientific, Bremen, Germany). Results: No significant difference was found between the two groups in terms of height, weight, and body mass index or serum B12 and folate concentrations (p>0.05). Children with severe amblyopia had lower vitamin B12 and folate and higher body mass index. The levels of phosphorus (p=0.012), selenium (p=0.002), molybdenum (p<0.001), iodine (p=0.002), chromium (p=0.022), boron (p<0.001), and beryllium (p=0.005) were all significantly lower in the amblyopia group compared to the control group. All of these minerals, except phosphorus, were also significantly lower in those with severe amblyopia compared to those with milder amblyopia and controls (p<0.05). Conclusion: Amblyopic children are significantly deficient in some inorganic elements. Inorganic elements, vitamin B12, and folate may play an important role in the visual development of amblyopic children.

RESUMO Objetivo: Nosso objetivo foi comparar o índice de massa corporal e o nível de vitaminas e minerais de crianças com e sem ambliopia. Métodos: Crianças amblióticas com idades entre 5 e 18 anos (n=46) e crianças controle pareadas por idade (n=32) foram avaliadas quanto a parâmetros antropométricos, incluindo altura, peso, índice de massa corporal e características demográficas. A vitamina B12 e o folato séricos foram medidos utilizando um analisador bioquímico Advia Centaur XP (Siemens, Irlanda). Avaliamos os elementos minerais inorgânicos de amostras de cabelo com espectrometria de massa de plasma indutivamente acoplado usando um analisador Thermo XSeries 2 (Thermo Fisher Scientific, Bremen, Alemanha). Resultados: Não houve diferença significativa entre os dois grupos em relação à altura, peso e índice de massa corporal ou concentrações séricas de B12 e folato (p>0,05). Crianças com ambliopia severa tinham menor vitamina B12 e folato e maior índice de massa corporal. Os níveis de fósforo (p=0,012), selênio (p=0,002), molibdênio (p<0,001), iodo (p=0,002), cromo (p=0,022), boro (p<0,001) e berílio (p=0,005) foram todos significativamente menores no grupo com ambliopia em comparação com o grupo controle. Todos esses minerais, exceto o fósforo, também foram significativamente menores naqueles com ambliopia em comparação com aqueles com ambliopia leve e grupo controle (p<0,05). Conclusão: As crianças amblíopes são significativamente deficientes em alguns elementos inorgânicos. Elementos inorgânicos, vitamina B12 e folato podem desempenhar um papel importante no desenvolvimento visual de crianças com ambliopia.

Is there any change in phenotypic characteristics comparing 5 to 10 years of follow-up in obese patients undergoing roux-en-y gastric bypass? / Características fenotípicas de pacientes com obesidade submetidos a derivação gástrica em y-de-roux: qual as reais mudanças comparando-se 5 a 10 anos de acompanhamento?

ABSTRACT Background : Bariatric surgery promotes significant weight loss and improvement of associated comorbidities; however, nutrients deficiencies and weight regain may occur in the middle-late postoperative period. Aim: To investigate nutritional status in 10 years follow-up. Methods : Longitudinal retrospective study in which anthropometric, biochemical indicators and nutritional intake were assessed before and after one, two, three, four, five and ten years of Roux-en Y gastric bypass through analysis of medical records. Results : After ten years there was a reduction of 29.2% of initial weight; however, 87.1% of patients had significant weight regain. Moreover, there was an increase of incidence of iron (9.2% to 18.5%), vitamin B12 (4.2% to 11.1%) and magnesium deficiency (14.1% to 14.8%). Folic acid concentrations increased and the percentage of individuals with glucose (40.4% to 3.7%), triglycerides (38% to 7.4%), HDL cholesterol (31 % to 7.4%) and uric acid (70.5% to 11.1%) abnormalities reduced. Also, there is a reduction of food intake at first year postoperative. After 10 years, there was an increase in energy, protein and lipid intake, also a reduction in folid acid intake. Conclusions : Roux-en Y gastric bypass is an effective procedure to promote weight loss and improve comorbidities associated with obesity. However, comparison between postoperative period of five and 10 years showed a high prevalence of minerals deficiency and a significant weight regain, evidencing the need for nutritional follow-up in the postoperative period.

RESUMO Racional: A cirurgia bariátrica promove importante perda ponderal e melhora das comorbidades associadas; entretanto, deficiências nutricionais e reganho de peso podem ocorrer no pós-operatório médio e tardio. Objetivo: Investigar a evolução do estado nutricional de pacientes após cinco e 10 anos de pós-operatório. Método: Estudo retrospectivo longitudinal, no qual indicadores antropométricos, bioquímicos e a ingestão alimentar foram avaliados no período pré-operatório e após um, dois, três, quatro, cinco e dez anos da operação, por meio de revisão de prontuários. Resultados: Após 10 anos observou-se redução de 29,2% do peso inicial; no entanto, 87,1% dos pacientes tiveram reganho significativo de peso. Além disso, houve aumento da incidência de deficiência de ferro (9,2% para 18,5%), vitamina B12 (4,2% para 11,1%) e magnésio (14,1% para 14,8%). As concentrações de ácido fólico aumentaram e a porcentagem de indivíduos com alterações na glicemia (40,4% a 3,7%), triglicérides (38% a 7,4%), colesterol HDL (31% a 7,4%) e ácido úrico (70,5% a 11,1%) diminuiu. Além disso, houve redução na ingestão alimentar no primeiro ano de pós-operatório. Após 10 anos, houve aumento na ingestão de energia, proteína e lipídios, e redução na de ácido fólico. Conclusões: A derivação gástrica em Y-de-Roux é procedimento eficaz para promover perda de peso e melhorar as comorbidades associadas à obesidade. Entretanto, a comparação entre os períodos pós-operatórios de cinco e 10 anos mostrou que uma porcentagem de pacientes apresenta deficiências de vitaminas e minerais e reganho de peso significativo, evidenciando a necessidade do acompanho nutricional no período pós-operatório.

Prevalência da deficiência de vitamina B12 em indivíduos portadores de diabetes mellitus tipo 2 em uso de metformina / Prevalence of vitamin B12 deficiency in type 2 diabetes mellitus individuals on metformin use

OBJETIVO: Observar a prevalência de baixas concentrações séricas de vitamina B12 em pacientes portadores de diabetes mellitus tipo 2 usuários de metformina e analisar eventual correlação dos níveis plasmáticos de vitamina B12 com sexo, idade, dose de metformina, tempo de uso, comorbidades e valores de hemoglobina glicada. MÉTODOS: Estudo do tipo transversal descritivo retrospectivo realizado por meio de coleta de dados em prontuários de pacientes atendidos no ambulatório de endocrinologia de um hospital em Curitiba (PR), entre janeiro de 2014 e dezembro de 2016. Foram incluídos todos os pacientes com diagnóstico de diabetes mellitus tipo 2, em tratamento com metformina por, no mínimo, 12 meses, e que possuíam registro de coleta sérica de vitamina B12. Foram excluídos pacientes submetidos à gastrectomia prévia e em suplementação de vitamina B12. RESULTADOS: Foram incluídos na amostra 290 pacientes, com predomínio na faixa etária de 50 a 70 anos (58,3%). Na amostra, 32,8% dos pacientes apresentaram deficiência nos níveis séricos de vitamina B12 (<200pg/mL) e 36,9% possível deficiência (200 a 300pg/mL), sendo que apenas 30,3% não apresentaram este défice. A maioria dos pacientes utilizou metformina por 5 a 15 anos e, destes, 31,7% apresentaram deficiência ou possível deficiência de vitamina B12. CONCLUSÃO: Os achados sugerem alta prevalência de deficiência e possível deficiência de vitamina B12 em pacientes diabéticos usuários de metformina. Tendo em vista a gravidade das possíveis micro e macrocomplicações advindas da deficiência, seriam ideais o rastreio da deficiência e a suplementação vitamínica em pacientes diabéticos usuários de metformina.(AU)

OBJECTIVE: To observe the prevalence of low vitamin B12 serum concentrations in Type 2 Diabetes Mellitus patients on use of metformin, and to analyze the possible correlation of plasma levels of vitamin B12 with: gender, age, metformin dose, time of use, comorbidities, and glycated hemoglobin values. METHODS: This is a retrospective descriptive cross-sectional study performed with data collection in medical records of patients attended at the endocrinology clinic of Hospital da Cruz Vermelha, in the city of Curitiba, state of Paraná, between January 2014 and December 2016. All patients diagnosed with Type 2 Diabetes Mellitus who were treated with metformin for at least 12 months and who had a serum vitamin B12 collection record were included. All patients undergoing previous gastrectomy and vitamin B12 supplementation were excluded. RESULTS: The sample consisted of 290 patients, predominantly in the 50-70 age group (58.3%). In the sample, 32.8% of the patients had vitamin B12 deficiency (<200 pg/ml), and 36.9% had a possible deficiency (200-300 pg/ml), with only 30.3% having no deficiency. Most patients used metformin for 5 to 15 years, and 31.7% had a deficiency or a possible deficiency of vitamin B12. CONCLUSION: The findings suggest a high prevalence of vitamin B12 deficiency, and possible deficiency in diabetic patients using metformin. Given the severity of possible micro- and gross complications from the deficiency, screening for deficiency and vitamin B12 supplementation in diabetic patients using metformin would be optimal.(AU)

Pancitopenia em pacientes com anemia perniciosa. Estudo descritivo de 33 casos. / Pancytopenia in patients with pernicious anemia. Descriptive study of 33 cases.

Objetivo: Discriminar as variáveis de sexo e idade nos pacientes com anemia perniciosa; estudar seu perfil hematimétrico; verificar a prevalência de outras doenças autoimunes e anemia perniciosa; analisar a incidência da pancitopenia e sua relação com alterações laboratoriais comum na doença; e avaliar a frequência dos autoanticorpos anticélulas parietais e antifator intrínseco. Métodos: Estudo transversal descritivo, de base clínica e laboratorial, de 33 prontuários de pacientes com anemia perniciosa, diagnosticados em um ambulatório de hospital terciário de atenção à saúde, no período de junho de 2009 a junho de 2014. Para analisar a relação da presença e da ausência de pancitopenia com os níveis da enzima lactato desidrogenase e vitamina B12, foi utilizado o teste qui quadrado. O programa utilizado foi o software Epi Info, versão 7. Resultados: Na amostra, 63,6% eram mulheres, e a idade média geral foi de 47,3 anos. Doenças autoimunes estavam associadas em 30,3% dos pacientes. A pancitopenia esteve presente em 39,4% dos pacientes. Houve significância estatística na relação da pancitopenia com os níveis de enzima lactato desidrogenase (p<0,05). A prevalência do antifator intrínseco foi de 69,7% e dos autoanticorpos anticélulas parietais foi de 72,7%. Conclusão: A pancitopenia mostrou-se um achado significante na população com anemia perniciosa, assim como níveis elevado de LDH, acrescentando a anemia perniciosa como um diagnóstico diferencial de tais alterações laboratoriais.(AU)

Objective: To discriminate the gender and age variables in patients with pernicious anemia; to study erythrocyte profile; to check the prevalence of other autoimmune diseases and pernicious anemia; to analyze the incidence of pancytopenia and its relationship with common laboratory abnormalities in the disease; to evaluate the frequency of anti-gastric parietal cell antibodies, and anti-intrinsic factor antibodies. Methods: Descriptive, cross-sectional study of clinical and laboratorybased medical records of 33 patients with pernicious anemia diagnosed in an outpatient's department of a tertiary healthcare center, in the period between June 2009 and June 2014. To analyze the relationship between the presence and absence of pancytopenia with levels of lactate dehydrogenase enzyme and levels of Vitamin B12 we used the chi-squared test. The software used was Epininfo version 7. Results: The sample showed 63.6% women and 36.4% men with a mean age of 47.3 years. Autoimmune diseases were associated in 30.3% of the patients. Pancytopenia was present in 39.4% of patients. There was statistically significant relationship of pancytopenia with lactate dehydrogenase enzyme levels (p <0.05). The frequency of anti-intrinsic factor antibodies was 69.7%, and the antigastric parietal cell antibodies was 72.7%. Conclusion: Pancytopenia proved to be a significant finding among the population with pernicious anemia and high levels of LDH, which includes pernicious anemia as a differential diagnosis of such laboratory alterations.(AU)

Prevalence of vitamin B12 deficiency in type 2 diabetic patients using metformin: a cross-sectional study / Prevalência de deficiência de vitamina B12 em pacientes diabéticos do tipo 2 usando metformina: um estudo transversal

ABSTRACT: CONTEXT AND OBJECTIVE: The prevalence of vitamin B12 deficiency varies from 5.8% to 30% among patients undergoing long-term treatment with metformin. Because of the paucity of data on Brazilian patients, this study aimed to determine the frequency of B12 deficiency and related factors among Brazilian patients with type 2 diabetes mellitus (T2DM) using metformin. DESIGN AND SETTING: Cross-sectional study at a public university hospital. METHODS: Patients with T2DM and a control group of non-diabetics were included. Serum B12 levels were measured and biochemical B12 deficiency was defined as serum levels < 180 pg/ml. Associations between B12 deficiency and age, duration of T2DM, duration of use and dosage of metformin, and use of proton pump inhibitors (PPIs) or histamine H2 antagonists were determined. RESULTS: 231 T2DM patients using metformin (T2DM-met) and 231 controls were included. No difference in the frequency of PPI or H2-antagonist use was seen between the groups. B12 deficiency was more frequent in the T2DM-met group (22.5% versus 7.4%) and this difference persisted after excluding PPI/H2-antagonist users (17.9% versus 5.6%). The factors that interfered with serum B12 levels were PPI/H2-antagonist use and duration of metformin use ≥ 10 years. Use of PPI/H2-antagonists was associated with B12 deficiency, with an odds ratio of 2.60 (95% confidence interval, 1.34-5.04). CONCLUSIONS: Among T2DM patients, treatment with metformin and concomitant use of PPI/H2-antagonists are associated with a higher chance of developing B12 deficiency than among non-diabetics.

RESUMO: CONTEXTO E OBJETIVO: A prevalência de deficiência de vitamina B12 varia de 5,8% a 30% nos pacientes em tratamento a longo prazo com metformina. Devido à escassez de dados em pacientes brasileiros, este estudo determinou a frequência de deficiência de B12 e fatores relacionados em pacientes brasileiros com diabetes mellitus tipo 2 (DM2) usando metformina. TIPO DE ESTUDO E LOCAL: Estudo transversal em hospital público universitário. MÉTODOS: Pacientes com DM2 e um grupo controle de não diabéticos foram incluídos. Os níveis séricos de vitamina B12 foram dosados e deficiência bioquímica de B12 foi definida como níveis séricos < 180 pg/ml. Foi investigada a associação entre deficiência de B12 e idade, duração do DM2, duração do uso e dose de metformina, uso de inibidores de bomba de prótons (IBP) ou antagonistas dos receptores histamínicos H2 (antagonistas-H2). RESULTADOS: 231 pacientes DM2 usando metformina (DM2-met) e 231 controles foram incluídos. Não houve diferença na frequência de uso de IBP/antagonistas-H2 entre os grupos. Deficiência de B12 foi mais frequente no grupo DM2-met (22,5% versus 7,4%) e essa diferença persistiu após exclusão dos usuários de IBP/antagonistas-H2 (17,9% versus 5,6%). Fatores que interferiram nos níveis séricos de B12 foram: uso de IBP/antagonistas-H2 e duração do uso de metformina ≥ 10 anos. O uso de IBP/antagonistas-H2 associou-se com deficiência de B12, com um risco relativo de 2,60 (95% intervalo de confiança, 1,34-5,04). CONCLUSÕES: Considerando pacientes com DM2, o tratamento com metformina e uso concomitante de IBP/antagonistas-H2 estão associados com maior chance de desenvolver deficiência de B12 quando comparado aos não diabéticos.

Pernicious anemia in patients with macrocytic anemia and low serum B12

The current research evaluated the prevalence of pernicious anemia [PA] in patients with macrocytic anemia [high MCV] and low serum B12 in Riyadh. Blood testing was done in 77 patients [males: 45.5%, females: 54.5%] with macrocytic anemia; 84 patients; [males: 23.8%, females: 76.2%] with low serum B12 and 30 healthy subjects. Complete blood count, differential count, folic acid, vitamin B12, intrinsic factor, gastric parietal cell antibodies and holotranscobalamin II were assessed. A total of five subjects from 161 patients had PA; three of these patients had macrocyticanemia [3.90%] and two patients had low serum B12 [2.38%]. Significant differences [p<0.05] in some hematological, immunological, biochemical parameters were found in subjects with macrocytic anemia and low serum B12 compared to controls. Pernicious anemia in patients with macrocytic anemia and low serum B12 was for the selected sample size can be assumed to be uncommon in Riyadh, Saudi Arabia

Association of Vitamin B12 Deficiency and Metformin Use in Patients with Type 2 Diabetes

We evaluated the prevalence of vitamin B12 deficiency and associated factors in type 2 diabetes patients using metformin. A total of 799 type 2 diabetes patients using metformin was enrolled. Vitamin B12 and folate levels were quantified by chemiluminescent enzyme immunoassay. Vitamin B12 deficiency was defined as vitamin B12 4 ng/mL). The prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes patients was 9.5% (n = 76), and the mean vitamin B12 level was 662.5 +/- 246.7 pg/mL. Vitamin B12 deficient patients had longer duration of metformin use (P or = 2,000 mg were 2.52 (95% CI, 1.27-4.99, P = 0.008) and 3.80 (95% CI, 1.82-7.92, P or = 10 yr were 4.65 (95% CI, 2.36-9.16, P 1,000 mg) and longer durations (> or = 4 yr) of treatment.

A Multicenter Retrospective Analysis of the Clinical Features of Pernicious Anemia in a Korean Population

To determine the approximate incidence and clinical features of pernicious anemia in a Korean population, we retrospectively analyzed clinical data for patients with pernicious anemia who were diagnosed between 1995 and 2010 at five hospitals in Chungnam province. Ninety-seven patients were enrolled, who accounted for 24% of patients with vitamin B12 deficiency anemia. The approximate annual incidence of pernicious anemia was 0.3 per 100,000. The median age was 66 (range, 32-98) yr, and the male/female ratio was 1.25. Anemia-associated discomfort was the most common symptom (79.4%), followed by gastrointestinal and neurological symptoms (78.4% and 38.1%, respectively). Pancytopenia was found in 36 patients (37.1%), and autoimmune disorders were found in 15 patients (15.5%). Antibody to intrinsic factor was detected in 62 (77.5%) of 80 patients examined, and antibody to parietal cells was detected in 35 (43.2%) of 81 patients examined. Of the 34 patients who underwent tests for Helicobacter pylori, 7 (12.5%) were positive. The anemia-associated and gastrointestinal symptoms resolved completely in all patients after intramuscular injection of cobalamin, whereas neurological symptoms remained in some. In conclusion, pernicious anemia is less frequent in Koreans than in Western populations; however, the clinical features of this disorder in Koreans do not differ from those of Western cases.

Vitamin B[12] deficiency and multiple sclerosis; is there any association?

Vitamin B[12] [Cobalamin] deficiency can result in some clinical and paraclinical characteristics similar to what is seen in multiple sclerosis [MS] patients. This study aimed to evaluate the controversial association between B[12] deficiency and MS. We measured serum vitamin B[12] in 60 patients with MS and 38 healthy controls. Clinical disability was evaluated according to the Extended Disability Status Scale [EDSS]. Serum B[12] concentration was measured with Radioimmunoassay Dual Isotope method. The cutoff value for low serum vitamin B[12] concentration was 75 pg/mL. Patients were in remission at the time of blood draw. There were 13 [21.6%] MS patients and 10 [26.3%] controls with low serum B[12] concentration with no significant difference between the groups; P>0.05. The mean serum vitamin B[12] concentration in MS patients [108.9 +/- 45.3 pg/mL] was not significantly different compared with controls [98.9 +/- 44.4 pg/mL]; P=0.284. Likewise, there was no correlation between the concentration of serum vitamin B[12] and disease' age of onset, duration, subtypes, or disability status. In contrast to some previous reports, our findings did not support any association between B[12] deficiency and MS

Sequential Involvement of the Nervous System in Subacute Combined Degeneration

PURPOSE: Subacute combined degeneration (SCD) involves progressive degeneration of the spinal cord, optic nerve, and peripheral nerves. Vitamin B12 (VB12) is a co-factor in myelin synthesis. Because each cell that constitutes the myelin component in the central nervous system and peripheral nervous system is different, it is improbable that these cells undergo simultaneous degeneration. However, the sequence of degeneration in SCD has not been established. MATERIALS AND METHODS: In this study, we analysed medical records and electrophysiological data of patients who showed neurological symptoms and whose serum VB12 levels were lower than 200 pg/mL. RESULTS: We enrolled 49 patients in this study. Their mean VB12 level was 68.3 pg/mL. Somatosensory evoked potential (SEP) study showed abnormal findings in 38 patients. Of the 40 patients who underwent visual evoked potential (VEP) study, 14 showed abnormal responses. Eighteen patients showed abnormal findings on a nerve conduction study (NCS). In this study, abnormal posterior tibial nerve SEPs only were seen in 16 patients, median nerve SEPs only were seen in 3 patients, abnormal VEPs only in two, and abnormal NCS responses in one patient. No patient complained of cognitive symptoms. CONCLUSION: In SCD, degeneration appears to progress in the following order: lower spinal cord, cervical spinal cord, peripheral nerve/optic nerve, and finally, the brain.

Association of Homocysteine Levels With Blood Lead Levels and Micronutrients in the US General Population / 예방의학회지

OBJECTIVES: Even though several epidemiological studies have observed positive associations between blood lead levels and homocysteine, no study has examined whether this association differs by the levels of micronutrients, such as folate, vitamin B6, and vitamin B12, which are involved in the metabolism of homocysteine. In this study, we examined the interactions between micronutrients and blood lead on homocysteine levels. METHODS: This study was performed with 4089 adults aged > or =20 years old in the US general population using the National Health and Nutrition Examination Survey 2003-2004. RESULTS: There were significant or marginally significant interactions between micronutrients and blood lead levels on mean homocysteine levels. Positive associations between blood lead and homocysteine were clearly observed among subjects with low levels of folate or low vitamin B6 (p-trend 15 micromol/L) as the outcome, there were similar patterns of interaction, though p-values for each interaction failed to reach statistical significance. CONCLUSIONS: In the current study, the association between blood lead and homocysteine differed based on the levels of folate, vitamin B6, or vitamin B12 present in the blood. It may be important to keep sufficient levels of these micronutrients to prevent the possible harmful effects of lead exposure on homocysteine levels.

Vitamin B12 deficiency & levels of metabolites in an apparently normal urban south Indian elderly population.

Background & objectives: There is no published literature on the extent of vitamin B12 deficiency in elderly Indians as determined by plasma vitamin B12 levels and methylmalonic acid (MMA) levels. Vitamin B12 deficiency is expected to be higher in elderly Indians due to vegetarianism, varied socio-economic strata and high prevalence of Helicobacter pylori infection. We therefore, studied the dietary habits of south Indian urban elderly population and measured vitamin B12, MMA red cell folate and homocysteine (Hcy) levels. Methods: Healthy elderly urban subjects (175, >60 yr) were recruited. Detailed history, physical examination and neurological assessment were carried out. Food Frequency Questionnaire (FFQ) for dietary analysis for daily intake of calories, vitamin B12, folate and detailed psychological assessment for cognitive functions was carried out. Blood samples were analyzed for routine haematology and biochemistry, vitamin B12, red cell folate, MMA and Hcy. Results: The mean age of the study population was 66.3 yr. Median values for daily dietary intake of vitamin B12 and folate were 2.4 and 349.2 μg/day respectively. Sixty two (35%) participants consumed multivitamin supplements. Plasma vitamin B12 level and the dietary intake of vitamin B12 was significantly correlated (P=0.157). Plasma vitamin B12 and Hcy were inversely correlated (P= -0.509). Red cell folate was inversely correlated with Hcy (P= -0.550). Significant negative correlation was observed between plasma vitamin B12 and MMA in the entire study population (P= -0.220). Subjects consuming vitamin supplements (n=62) had significantly higher plasma vitamin B12 levels, lower MMA levels and lower Hcy levels. There was no significant correlation between plasma vitamin B12, MMA, Hcy and red cell folate and any of the 10 cognitive tests including Hindi Mental Status Examination (HMSE). Interpretation & conclusions: Our study is indicative of higher vitamin B12 (2.4 μg/day) intakes in urban south Indian population. Thirty five per cent of the study population consumed multivitamin supplements and therefore, low plasma vitamin B12 levels were seen only in 16 per cent of the study subjects. However, MMA was elevated in 55 per cent and Hcy in 13 per cent of the subjects.

[Folic acid and vitamin B12 status in healthy preschool children in Tehran, Iran, 2010]

A deficiency of folate or vitamin B12, particularly in tissues with a high cell replication rate, could inhibit RNA and DNA synthesis, DNA methylation, as well as cell maturation. Therefore, a sufficient intake of these vitamins in childhood is of vital importance. Since there are no published reports on the status of folic acid and vitamin B12 in Iranian children, the present study was conducted to assess serum and red blood cells concentrations and some related factors in healthy 3-6 year old children in Tehran, Iran, 2010. This was a cross-sectional, descriptive-analytical study, in which 228 children, 3-6 year old [105 girls and 123 boys], were selected by random systematic cluster sampling from 20 [out of 270] day-care centers in Tehran. A 2-ml non-fasting blood sample was drawn from each child and analyzed for serum and red blood cell folate and vitaminB12 by the RIA method. SPSS.16 was used for data analysis, the statistical tests being t-test, Chi-square and ANOVA. There were no significant differences between the 2 sexes with regard to age, weight, height, BMI, RBC folate, or serum folate and vitamin B12 levels. Based on the serum folate level, 9.6% and 37.8% of the children suffered from severe and mild deficiency, respectively; 52.6% had normal folate serum levels. The data also showed that 97.4% of the children had a normal serum vitamin B12 level, only 2.6% being mildly deficient. As judged by the RBC folate level, of 105 children [60 boys and 45 girls], 1% and 37% had severe and mild deficiency, respectively, an absolute majority [62%] having normal levels. The distributions of serum folate, serum vitaminB12, and RBC folate levels were not statistically different between boys and girls. Similarly, no associations were observed between the RBC folate level, serum folate level, or serum vitamin B12 level and age, weight, height, family size, birth order, or head of the family. There were positive significant correlations between serum folate on the one hand and RBC folate [r=0.4, p<0.001] and serum vitamin B12 [r=0.8, p<0.001] on the other hand. Furthermore, folate, RBC folate, and serum vitamin B12 were all positively related to father's education [p=0.01], mother's education [p=0.008] and father's job status [p<0.027]. In addition, the vitamin levels were higher in children of the working mothers, as compared to those of non-working mothers [p<0.036]. There were no differences between the 2 groups with regard to other variables. Folate deficiency is highly prevalent, while the deficiency of vitamin B12 is low, among Tehrani preschoolers. It is recommended to design and implement suitable intervention programs. Major components of such programs should be mothers' nutrition education and improving family food consumption patterns with particular emphasis on optimum utilization of folate sources, particularly vegetables

Vitamin B12 for the treatment of recurrent aphthous stomatitis

The purpose of this study was to confirm the beneficial effects of Vitamin 12 in the treatment of Recurrent Aphthous Stomatitis. This study was conducted at the Department of Oral Medicine of Khyber College of Dentistry, Peshawar on 65 patients suffering from Recurrent Aphthous stomatitis. The patients were randomly divided in to two groups A sublingual dose of Vitamin B12 500 mcg and 1000 mcg was administered to the two groups for 6 months. There were 35 patients in Group-I who were given l000mcg Vitamin B 12 sublingually while in Group-II, 30 patients were given 500 mcg Vitamin B 12 sublingually for 6 months at bed time. The parameter has been recorded in each group on monthly basis for 6 months. The level, duration of pain, the number of outbreak and the size of ulcer was considerably reduced in patients who were treated with Vitamin B 12 l000mcg irrespective of blood Vitamin 12 level as compared to patients taking 500 mcg Vitamin B 12. There was no Recurrent Aphthous stomatitis in Group-I at the end of 6 months while in Group-II there was 30% relief. Thus Vitamin B 12 1 000 mcg sublingually in the treatment of Recurrent Aphthous ulceration is a safe, effective, inexpensive and low risk treatment regardless of serum Vitamin B 12 level in the blood

Assessment of serum vitamin B12 and folic acid in patients with oral Lichen Planus: a case control study

Oral Lichen Planus [OLP] is a chronic immunologic disorder with unknown etiology. Stress and anxiety are some risk factors for OLP and Vitamin B12 and folic acid have been proved to be effective mirco-nutrients for prevention of anxiety and depression. The purpose of this study was to investigate serum Vitamin B12 and folic acid deficiency in patients with OLP. Forty eight individuals [32 cases with histopathologically proven OLP and 16 healthy subjects] were recruited. Serum folic acid and Vitamin B12 were assessed for each individual. T-test was applied for data analysis. Vitamin B12 deficiency was found in 8 of 32 cases with OLP [25%] while in the control group it was found in 12.5% of the subjects [p>0.05]. Of the 32 patients with OLP, one had folic acid deficiency while none of the control subjects had such a deficiency [p>0.05]. Although Vitamin B12 deficiency in OLP patients did not show a statistically significant difference compared with healthy subjects, it was approximately twice as much as the control group. And it can be suggested that Vitamin B12 may have some effective roles in OLP pathogenesis while folic acid deficiency cannot be considered as a prominent risk factor in OLP. More studies are needed to prove such relation

Maternal folate and vitamin biz status and neural tube defects in northern Iran: a case control study

This study was conducted to determine the serum level in neural tube defects pregnancies [NTD] and healthy controls in Northern Iran. This case-control study was performed on women with neural tube defects pregnancies and controls with unaffected pregnancies in Northern Iran during 2006. Twenty three pregnant women whose pregnancies were diagnosed as NTD by a second-trimester ultrasonographic examination were recruited as cases. The control group [n=23] consisted of women who were selected among socio-economic status [SES] matched women who had a normal targeted ultrasound during the second trimester with documented normal fet al outcome. Fetal NTD was suspected with targeted second-trimester ultrasound during the 16[th] week of gestation and confirmed with high maternal serum a-fetoprotein levels. Folate, vitamin 812, homocysteine and alpha fetoprotein were evaluated after target ultrasonography. Serum alpha fetoprotein level [mean +/- SD] in cases and controls was 120.2 +/- 64.1 and[tm]50 +/- 33.5 iu /ml, respectively [P<0.05]. The mean +/- SD folate in cases and controls was 8.4 +/- 4.2 versus 9.3 +/- 4.2 ng/ml, respectively. This difference was not significant. Folate deficiency was found in 30.4% of the cases and 13% of the controls [OR = 2.9, 95%: 0.54-19.8]. Vitamin B12 deficiency was found in 13% of cases and 17.7% of the controls [OR=0.7, 95%: 0.1-4.9]. This study showed that the probability of having a newborn with NTDs in maternal folate deficiency is three times higher than with normal folate in Northern Iran

Megaloblastic anemia patient admitted with pancytopenia and walking difficulty with normal vitamin B12 and MCV levels

Vitamin B12 deficiency may cause hematologic, gastrointestinal, psychiatric and neurological symptoms. Sub-acute combined degeneration of spinal cord, which develops in the deficiency of vitamin B12, may be reversible in case of early diagnosis and treatment. We describe the management of a 50-years old female who got admitted with pancytopenia and elevated LDH, with walking difficulties since last 15 days. B12 and folic acid levels were found in normal ranges. Megaloblastic changes were observed in the bone marrow examination. Abnormal hyperintence signal changes were observed in T2-weighed cervical spinal cord Magnetic Resonance Imaging in posterior row. Due to the high homocysteine level, treatment with parenteral B12 vitamin was initiated. Following the 3-months treatment, hematologic counts and neurological symptoms of the patient were found to be completely recovered at the control visit. Vitamin B12 deficiency should be considered for the patients with pancytopenia, elevated LDH levels and neurological symptoms, even if vitamin B12 and MCV levels are in normal ranges. Vitamin B12 deficiency should be confirmed with the additional assays, such as, the assessment of serum homocysteine and methylmalonic acid levels, and the treatment should be started promptly