Prevalence of mild serum vitamin B12 deficiency in rural and urban Costa Rican young adults.

OBJECTIVE: Recent studies have shown an increase of mild serum cobalamin (vitamin B12) deficiency in some Latin American countries; however, no data are available from Costa Rica. The purpose of this work was to establish the prevalence of serum vitamin B12 deficiency among Costa Rican young adults and to study some factors that may help explain the serum cobalamin concentrations. METHODS: A cross-sectional survey was conducted among 400 adults aged 20 to 40 years old from urban and rural areas of the central valley of Costa Rica to determine serum vitamin B12 levels. Additionally, cobalamin dietary intake and the detection of Helicobacter pylori IgG antibodies were studied as possible determinants of the serum vitamin B12 concentrations. RESULTS: The mean serum concentration of vitamin B12 was 268 ± 125 pmol/L, and no significant differences were found by gender or area. Study data indicate an overall prevalence of inadequate serum cobalamin levels of 42.4% (11.2% deficient and 31.2% marginal); more than 50% but less than 75% of individuals had an intake of vitamin B12 below the U.S. Estimated Average Requirement (EAR) and 61.2% had IgG antibodies to H. pylori. CONCLUSIONS: The prevalence of mild serum vitamin B12 deficiency in young Costa Rican subjects is as high as in other Latin American countries. More investigation should be done to elucidate the etiological factors that are generating deficient and marginal serum cobalamin levels in Costa Rican adults in order to define appropriate public health actions.

Pseudodementia in a twenty-one-year-old with bipolar disorder and vitamin B12 and folate deficiency

A twenty-one-year-old female known to suffer from bipolar type 1 disorder developed features of a pseudodementia. Following prompt initial response to treatment with antidepressants, there was an early recurrence of cognitive impairment. Blood investigations confirmed a macrocytic anaemia and vitamin B12 and folate deficiencies. There was dramatic resolution of cognitive impairment after vitamin replacement. This suggested the occurence of a reversible nutritional dementia and reinforced the need to rule out secondary organic causes of psychiatric symptoms even in patients previously diagnosed with a primary psychiatric disorder.(Au)

Optimization of daily folate, vitamin B12 and vitamin B6 supplements in paediatric patients with sickle cell disease

We determined optimal folate, vitamin B12 and vitamin B6 dosages in 21 sickle cell disease (SCD) patients (11 HbSS, 10 HbSC; mean 7 years, range 7-16), using plasma homocysteine (Hcy) as functional marker. They received daily 400 g (0-3 weeks), 700 g (3-6) and 1000 g (6-70) folate; 1 (0-21), 3 (21-45 and 5 RDA (45-70) vitamin B12; and 1 RDA vitamin B6 (0-70). Blood was taken at baseline (P0) and after 3 (PI), 6 (P2), 9 (P3), 21 (P4), 33 (P5), 45 (P6), 57 (P7) and 70 (P8) weeks for measurement of erythrocyte (RBC), serum folate, plasma vitamin B12, whole blood vitamin B6 and plasma Hcy. Vitamin B6 increased from P0 to P1 and P1 to P2; vitamin B12 from P4 to P8; serum folate from P0 to P1 and P1 to P2; RBC folate from P0 to P1, P1 to P2 and P2 to P3. Hcy decreased from P1 to P2 and P4 to P6. Most pronounced Hcy decreases occurred from P0 to P1 (43 percent of patients), P1 to P2 (14 percent) and P4 to P5 (24 percent). Haematological indices did not change. Patients with HbSS had higher RBC folate at P1, P2 and P8. The entire group exhibited inverse relations between RBC folate and haemoglobin on P1, P2, P3, P6, P7 and P8. We conclude that RBC folate is less valuable for folate status assessment in SCD patients. The optimal daily supplement is 700 g folate (3.5-7 RDA vitamin B12 (4.2-6.0 g) and 1 RDA vitamin B6 (1.4-2.0 mg). This combination causes Hcy levels that do not decrease further upon higher dosages and may reduce by simple and relatively inexpensive means their inherently high risk of endothelial damage.(Au)

Folic acid status of paediatric patients with sickle cell disease

We investigated whether paediatric patients with sickle cell disease (9ñ4 years; 27 HbSS; 19 HbSC) have different folic acid status compared with age-, sex-and race-matched HbAA controls (n=20), and whether their folic acid status can be improved by folic acid supplementation. The patients were supplemented with vitamins B6 and B12 during one week and with folic acid during the next week. Circulating folic acid, homocysteine, vitamin B6 and vitamin B12 levels were measured at baseline (patients and controls), after 1 and 2 weeks (patients). The patients had similar folic acid, vitamin B6 and vitamin B12, but higher homocysteine levels, compared with HbAA controls (12.7ñ4.5 vs 10.9ñ3.5 mmol/l;p=0.04). Vitamin B6 and B12 supplementation did not change their homocysteine levels, but folic acid supplementation caused a 52 percent reduction (to 5.7ñ1.6). We conclude that patients with sickle cell disease have adequate vitamin B6 and B12 status, but suboptimal folic acid status. They may benefit from folic acid supplementation to reduce their high risk for endothelial damage.(AU)

Haematinic deficiences in British patients with recurrent aphthous stomatitis

Recurrent aphthous stomatitis (RAS) affects up to 25 percent of the population. Though predominantly idiopathic, there are many aetiological factors, among them anaemia and deficiencies of iron, folic acid and vitamin B12. There continues to be controversy over the necessity for haematinic analysis in addition to a complete blood count. The records of 222 patients with RAS (85.6 percent minor, 8.6 major, 2.7 percent herpetiform and 3.1 percent Behcet's syndrome), ranging in age from 4 to 79 years, were therefore scrutinised for the results of the complete blood count, serum ferritin and vitamin B12 and red blood cell folate levels. Anaemia was diagnosed in 14 percent of patients, aged 15 years or less, male and female, and 6 percent of patients of both sexes aged over 15 years. Around 25 percent of females and 10 percent of males had reduced ferritin, 9 percent and 5 percent, respectively, had reduced vitamin B12 and 3 percent had reduced red cell levels. There was poor correlation between the finding of haematinic deficiency and abnormalities in the complete blood count. It is concluded that haematinic deficiency investigations are justified in cased of RAS and that a full blood count alone is adequate.(AU)

Rastafarianism and the vegans syndrome

Low serum vitamin B12 concentrations are common in vegans. We report the first account of the syndrome in members of the Rastafarian cult, which started in Jamaica more than 40 years ago (AU)

Nutritional vitamin B12 deficiency among Hindus

Ten cases of nutritional vitamin B12 deficiency are described among Hindus in Trinidad, West Indies. All patients, save one, were vegetarians. This dietary rule, while permitting dairy produce, forbade other food material of animal origin. The survivors showed an excellent reponse to treatment with vitamin B12. The majority of patients exhibited mental disturbances of varying degree which appeared to be related causally to deficiency of vitamin B12. The data presented and a review of the literature suggest that megaloblastic anaemia caused solely by dietary deficiency, that is, unrelated to absorptive defects, pregnancy or other conditioning factors, may be rare outside communities among whom the practice of vegetarianism is common. (Summary)

Non-Addisonian vitamin B12 deficiency anaemia in Trinidad (abstract only)

Of 12 cases of megaloblastic anaemia in adults not associated with pregnancy seen during the period 1st April, 1959 to 31st January, 1960, six cases were of Non- Addisonian type. Four cases were Addisonian type and the remaining two cases died before full work up had been done. With one exception Vitamin B12 in a dose of 100 micrograms I.M. daily was the only haematinic used. In the single exception folic acid was given in addition on the sixth day after a reticulocyte and clinical response to Vitamin B12 had been noted. It was therefore, believed to be established that the anaemia in the Non-Addisonian group could be corrected completely by the use of Vitamin B12 only. The noteworthy features in this Non-Addisonian group were as follows:- All were Hindus and with one exception these were strict vegetarians eating no eggs, meat, fowl or fish. The grounds for these dietary prohibitions appeared to be religious. Severe mental symptoms were nearly always present, namely, intellectual dullness, amnesia and confusion with frankly psychotic reactions in two patients. These mental symptoms improved following treatment. Other features of this group were sore tongue (2 cases), fever (4 cases), icterus (4 cases) and splenomegaly (2 cases). The pyrexia appears to be related solely to the specific deficiency. The low levels of Hb (none above 30 percent) observed in this group at time of diagnosis, suggests that early cases are for some reason being missed. The status of the two patients who died before full work up is uncertain. One may belong to the Non- Addisonian group. No unusual features were noted among the four cases of Addisonian anaemia. The incidence of this condition among non-European peoples may be higher than previously suspected. The pathogenesis of non-Addisonian B12 deficiency is discussed. It is suggested that poverty and a vegetarian diet combine in certain individuals to produce this state. Vitamin B12 rather than folic acid deficiency develops presumably because folic acid is widely distributed among leafy vegetables. (However, no special folic acid studies were done) (AU)

Megaloblastic anaemia of infancy in Jamaica

The literature on megaloblastic anaemia of infancy is briefly reviewed with particular reference to its occurence with protein malnutrition (kwashiorkor). The clinical, haematological and other laboratory findings in 50 cases of megaloblastic anaemia of infancy are presented. From a clinical point of view the most striking feature is that almost all the infants were malnourished and grossly underweight. The bone marrow morphology is described, and the diagnostic value of special changes in the granulocyte series is stressed. An interesting pathological finding was the presence of extramedullary erythropoesis in the liver. This was found at necropsy in three out of six cases and on liver biopsy in seven out of ten cases. Although not constantly present, extramadullary erythropoesis is thought to be pathognomonic of the disease. Of the fifty cases in the series 45 were given folic acid and five received vitamin B12. Six of the folic acid treated cases died. The response to both folic acid and vitamin B12 in the remaining cases was excellent. No response to antibiotics was noted. The pathogenesis of the disease is discussed in some detail and illustrated with cases. Although there is no doubt of the importance of ascorbic acid deficiency and of infection in the aetiology of megaloblastic amaemia of infancy, it seems probable that a dietary deficiency of essential haemopoietic factors is the major cause. Whether the main deficiency is of folic acid or of vitamin B12 is uncertain at the present time, although in our view a deficiency of folic acid seems to likely to be the more important (Summary)