Higher incidence of metabolic syndrome components in vitiligo patients: a prospective cross-sectional study

Abstract Background/Objectives: To investigate the association between vitiligo and metabolic syndrome. Methods: A prospective cross-sectional study was conducted between 2014 and 2016. Study (n = 155) and control groups (n = 155) were evaluated for metabolic syndrome according to National Cholesterol Education Program Adult Treatment Panel III and the International Diabetes Federation criteria. Study group was divided into three groups according to their vitiligo area severity index and vitiligo disease activity score values (Group 1: 6.89 for VASI score, Group A: −1-0, Group B: 1-2 and Group C: 3-4 for vitiligo disease activity score respectively). MetS rates according to both criteria were compared between the vitiligo disease activity score and vitiligo area severity index groups. Results: Metabolic syndrome rates were 37.4% and 40% in the study group and 19.4% and 26.5% in the control group according to National CholesterolEducation Program Adult Treatment Panel III and International Diabetes Federation criteria, respectively (p < 001 and p = 0.011). Metabolic syndrome was more frequent in vitiligo area severity index Groups 2 and 3 compared to vitiligo area severity index Group 1, and in vitiligo disease activity score Group C compared to vitiligo disease activity score Groups A and B. Study limitations: Single center experience, absence of more specific oxidative-stress markers and lack of long-term follow-up of the patients. Conclusions: Frequency of metabolic syndrome was higher in patients with non-segmental vitiligo and the rate was higher in active/severe form of the disease.

Vitamin B12 deficiency in India: Mean corpuscular volume is an unreliable screening parameter.

Background. Vitamin B12 deficiency is thought to be more common than was previously believed, but there are little data from India on this. It has protean clinical manifestations, and raised mean corpuscular volume (MCV) is commonly used by physicians as an indicator for megaloblastic anaemia caused by vitamin B12 deficiency. We evaluated the clinical profiles of our patients with vitamin B12 deficiency and tried to ascertain how useful MCV and the peripheral smear were in diagnosis. Methods. We evaluated the clinical picture, haematology indices and peripheral smear findings of 117 patients with low vitamin B12 levels. Serum folic acid, ferritin values and biopsy findings of some patients were also assessed. Results. Patients were commonly detected to have reduced levels of serum vitamin B12 during the work-up for anaemia (n=45) or for neurological symptoms (n=31). Of the 94 cases in which smears were examined, 26 showed macrocytes and hypersegmented neutrophils were present in 24. Twentysix patients showed a raised MCV, 50 patients had an MCV within the reference range and 28 had low MCV. Pancytopenia was present in 5 patients. Concomitant iron deficiency, as judged by serum ferritin levels, was present in 18 patients. Conclusion. Vitamin B12 deficiency is not uncommon in India. It is often diagnosed during the work-up for a haematological disorder or for neurological symptoms. MCV is unreliable as a screening parameter for the presumed diagnosis of macrocytic anaemia, which is associated with vitamin B12 deficiency.

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.

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.

[ study of folate and cobalamin deficiency in elderly by determining a cut-off point with laboratory markers]

Prevalence of folate and cobalamin deficiency in elderly is high. Determining a cut off point for low and marginal levels of folate and cobalamin deficiency before development of anemia or neurocognitive presentations in elderly is essential. In this cross-sectional study 280 persons above 65 years old in the twelve regions of Mashhad city were admitted to Emam Reza [pbuh] hospital. They were physically examined by a general practitioner. Other data were obtained by questionnaire. Serum cobalamin and folate level were analyzed by RIA method. 76 persons, who had cobalamin of 120-450 pg/ml and folate of 1.5-7 ng/ml without any interfering factor for homocystein [Hey] measurement [creatinin> 1.5 g/dl, cigarette smoking and consuming certain kind of drugs] were analyzed for serum homocystein by Elisa method. All collected data was statistically analyzed by SPSS software. 48.7% of elderly had hyperhomocysteinemia. Hey was inversely correlated with cobalamin [p=0.001] and folate below cut off point [p=0.044]. For Hcy>15 mol/micro, cut off points for cobalamin and folate deficiency were <330 pg/ml and <6.5 ng/ml respectively. Prevalence of cobalamin deficiency in low levels [<122 pg/ml] was 22.7% and in marginal levels [122-330 pg/ml] was 51.8%. Prevalence of folate deficiency in low levels [<3 ng/ml] was 16.7% and in marginal levels [<6.5 ng/ml] was 64.2%. According to definition of cut off point, Prevalence of cobalamin and folate deficiency especially in marginal levels was higher than which is recorded. It is recommended that before development of signs and symptoms and other complications of hyperhomocysteinemia, all elderly patients undergoes screening for cobalamin and folate deficiency in appropriate intervals

Vitamin B12 and homocysteine status in asymptomatic Indian toddlers.

Low serum vitamin B(12) (V B(12)) and hyperhomocysteinemia have been reported in asymptomatic Asian Indian men. We studied the prevalence of V B(12) deficiency and hyperhomocysteinemia in 51 asymptomatic toddlers, from Pune, India. V B(12) levels were low and total serum homocysteine was high in 14% and homocysteine levels were significantly higher in boys. Programming for cardiovascular risk in adulthood possibly starts at a very young age through the homocysteine axis.

Anemia due to folic acid, vitamin B12 and iron deficiencies in some pregnant and non-pregnant women in Kerman city

Fifty-three pregnant and 58 non-pregnant women, attending one of the hospitals in Kerman city, were selected according to set criteria and included in the study. The mean age was 24 years and the mean panty two. Nutritional status was assessed on the basis of blood and serum biochemical parameters. Results obtained showed that 4%, 3%. 17%, 12% and 13.3% of the women have low level of Hb, Hct MCV MCHC and MCH, respectively. Also, the percentages of women suffering from a deficiency of folic acid, vitamin B12 and iron were 16.9%, 7% and 8.7% respectively. In 18.7% of the subjects the transferrin saturation percentage was lower, and in 46.6% of them TIBC was higher, than normal

Vitamin B12, folic acid and haematological status in elderly Thais.

Serum vitamin B12, folic acid and haematological data from 147 elderly people (55 males and 92 females) who visited the special clinic for the elderly at Rajvithi Hospital, Bangkok between July and November 1989 were investigated. The individuals studied came from a health-conscious group of the middle socio-economic class in Bangkok. All of them were fairly well except for minor ailments and typical diseases of elderly people such as hypertension, mild to moderate degree coronary heart diseases and non-insulin dependent diabetes mellitus. There was a statistically significant difference in haemoglobin concentrations between males and females. According to the standard haemoglobin cut-off point values of 13 g/dl for males and 12 g/dl for females, anaemia was detected in 22 (15%) of the 147 subjects. The percentage of folic acid deficiency was found to be 20.6 per cent (30 of the 147 cases). Vitamin B12 insufficiency was found in only 6.9 per cent (10 of the 147 cases). No statistically significant correlation between haemoglobin, folic acid and vitamin B12 was found. However, when the data were grouped according to different intervals of increasing haemoglobin concentrations, for females there was a tendency for serum vitamin B12 to decrease, and serum folic acid to increase in both males and females. The results of this study suggest that folate deficiency may play a role in the occurrence of anaemia in elderly people, and therefore, dietary counselling and supplementation of folic acid are recommended.

Vitamin B12 deficiency: report of a childhood case.

An 11-year-old boy who presented with anemia, premature grey hair, hyperpigmented skin, paresthesia, recurrent aphthous ulcers and epistaxis was eventually proved to be a case of vitamin B12 deficiency. Due to the paucity of this deficiency, the diagnosis may easily be delayed and overlooked resulting in unfavorable consequences. Therapeutic response to vitamin B12 was dramatic in this reported case.