Perspective: Practical Approach to Preventing Subclinical B12 Deficiency in Elderly Population.

Vitamin B12 (also known as cobalamin) is an essential water-soluble vitamin that plays a pivotal role for several physiologic functions during one's lifespan. Only certain microorganisms are able to synthetize B12, thus humans obtain cobalamin exclusively from their diet, specifically from animal-derived foods. Specific sub-group populations are at risk of vitamin B12 subclinical deficiency due to different factors including poor intake of animal source foods and age-dependent decrease in the capacity of intestinal B12 uptake. Consumption of animal products produces some negative health issues and negatively impacts sustainability while a plant-based diet increases the risk of B12 deficiency. Taking a cue from the aforementioned considerations, this narrative review aims to summarize facts about B12 deficiency and the burden of inadequate dietary intake in elderly population, as well as to discuss sustainable approaches to vitamin B12 deficiency in aging population.

Vitamin B12 supplementation orally and intramuscularly in people with obesity undergoing gastric bypass.

PURPOSE: Although bariatric surgery can facilitate weight loss and improve many diseases, it impairs the absorption of many vitamins and micronutrients. Vitamin B12 is important for these patients and should be controlled and supplemented postoperatively. The aim of this paper is to compare serum vitamin B12 levels in two forms of supplementation (oral vs. intramuscular) for 6 months after gastric bypass. METHODS: In a prospective controlled cohort study, people with obesity patients undergoing gastric bypass received vitamin B12 supplementation either orally or intramuscularly. The patients were followed for 6 months, receiving serial doses of vitamin B12 and methylmalonic acid assessment at 6 months. RESULTS: A total of 53 patients were divided into two homogeneous groups: an oral group (n=24) and an intramuscular group (n=29). Serum vitamin B12 was measured preoperatively and postoperatively at 1, 2, 3, and 6 months. Serum methylmalonic acid was measured at 6 months. At each point, the serum vitamin B12 level remained within reference values in both groups, although it was higher in the oral group (p<0.001). Methylmalonic acid also remained within reference values in both groups, with no significant differences. CONCLUSION: Despite the anatomical and functional alterations that impair vitamin B12 absorption after gastric bypass, oral vitamin B12 supplementation was as effective as intramuscular in this population.

Medium term post-bariatric surgery deficit of vitamin B12 is predicted by deficit at time of surgery.

BACKGROUND: Patients with morbid obesity have a high risk of deficits in micronutrients, after bariatric surgery. The reasons why systematic use of multivitamin and trace element supplements cannot prevent all deficits are complex and should deserve more attention. Little is known about the influence of micronutrient deficits at surgery. AIM: This present study aimed to explore the deficit in vitamin B12 vs other micronutrients during the follow-up of a French cohort of cases with bariatric surgery under systematic multivitamin/trace elements supplementation and to determine whether it was influenced by clinical, metabolic characteristics at surgery. METHODS: We prospectively enrolled obese patients with bariatric surgery (laparoscopic gastric bypass or laparoscopic sleeve gastrectomy) between 2013 and 2018 (OBESEPI/ALDEPI Cohort, NCT02663388). They received a daily multivitamin/micronutrients supplement. Follow-up data at 4 visits, 2, 12, 18 and 24 months after surgery, were collected. RESULTS: The highest rate of deficits was observed at visit 1 for vitamin D (35.7%), iron (21.9%) and folate (10.2%). Except B12, the deficits of all micronutrients decreased in later visits. In contrast, cases with vitamin B12 deficit decreased from 13.5% at surgery to 2.0% at visit 1, and increased in later visits, with a maximum of 12.0% at visit 3. Vitamin B12 concentration at surgery was the single predictor of B12 deficit at visit 3. It was also associated with age, and APRI score, an index of nonalcoholic fatty liver disease (NAFLD), in multivariate analysis. CONCLUSIONS: The failure of systematic supplementation with multivitamin/trace elements tablets to prevent specific deficits illustrates the need for adapted specific supplementations, in some cases. The worsening of B12 deficit rate in the 18-24 months follow-up depends in part to low B12 at time of surgery. A special consideration should be devoted to this subset of patients. The cohort study was registered at clinicaltrials.gov as NCT02663388.

Effects of vitamin B12 supplementation on neurodevelopment and growth in Nepalese Infants: A randomized controlled trial.

BACKGROUND: Vitamin B12 deficiency is common and affects cell division and differentiation, erythropoiesis, and the central nervous system. Several observational studies have demonstrated associations between biomarkers of vitamin B12 status with growth, neurodevelopment, and anemia. The objective of this study was to measure the effects of daily supplementation of vitamin B12 for 1 year on neurodevelopment, growth, and hemoglobin concentration in infants at risk of deficiency. METHODS AND FINDINGS: This is a community-based, individually randomized, double-blind placebo-controlled trial conducted in low- to middle-income neighborhoods in Bhaktapur, Nepal. We enrolled 600 marginally stunted, 6- to 11-month-old infants between April 2015 and February 2017. Children were randomized in a 1:1 ratio to 2 µg of vitamin B12, corresponding to approximately 2 to 3 recommended daily allowances (RDAs) or a placebo daily for 12 months. Both groups were also given 15 other vitamins and minerals at around 1 RDA. The primary outcomes were neurodevelopment measured by the Bayley Scales of Infant and Toddler Development 3rd ed. (Bayley-III), attained growth, and hemoglobin concentration. Secondary outcomes included the metabolic response measured by plasma total homocysteine (tHcy) and methylmalonic acid (MMA). A total of 16 children (2.7%) in the vitamin B12 group and 10 children (1.7%) in the placebo group were lost to follow-up. Of note, 94% of the scheduled daily doses of vitamin B12 or placebo were reported to have been consumed (in part or completely). In this study, we observed that there were no effects of the intervention on the Bayley-III scores, growth, or hemoglobin concentration. Children in both groups grew on an average 12.5 cm (SD: 1.8), and the mean difference was 0.20 cm (95% confidence interval (CI): -0.23 to 0.63, P = 0.354). Furthermore, at the end of the study, the mean difference in hemoglobin concentration was 0.02 g/dL (95% CI: -1.33 to 1.37, P = 0.978), and the difference in the cognitive scaled scores was 0.16 (95% CI: -0.54 to 0.87, P = 0.648). The tHcy and MMA concentrations were 23% (95% CI: 17 to 30, P < 0.001) and 30% (95% CI: 15 to 46, P < 0.001) higher in the placebo group than in the vitamin B12 group, respectively. We observed 43 adverse events in 36 children, and these events were not associated with the intervention. In addition, 20 in the vitamin B12 group and 16 in the placebo group were hospitalized during the supplementation period. Important limitations of the study are that the strict inclusion criteria could limit the external validity and that the period of vitamin B12 supplementation might not have covered a critical window for infant growth or brain development. CONCLUSIONS: In this study, we observed that vitamin B12 supplementation in young children at risk of vitamin B12 deficiency resulted in an improved metabolic response but did not affect neurodevelopment, growth, or hemoglobin concentration. Our results do not support widespread vitamin B12 supplementation in marginalized infants from low-income countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT02272842 Universal Trial Number: U1111-1161-5187 (September 8, 2014) Trial Protocol: Original trial protocol: PMID: 28431557 (reference [18]; study protocols and plan of analysis included as Supporting information).

Dietas vegetarianas en alumnos universitarios / Vegetarian diets in first year university students

INTRODUCCIÓN: Se ha observado un aumento en la popularidad de las dietas vegetarianas, en especial en la población adolescente y adulto joven. Estas dietas se presentan como saludables y balanceadas pero las recomendaciones son controversiales en cuanto a los potenciales déficit nutricionales. OBJETIVO: Identificar la frecuencia y tipos de dieta vegetariana utilizada, su motivación y fuentes de información. PACIENTES Y MÉTODO: Estudio transversal y analítico en universitarios de primer año de la Pontificia Universidad Católica de Chile (PUC). Se realizó una encuesta vía online obteniendo información demográfica y caracterización de dietas de aquellos que se consideraban vegetarianos. Las variables fueron analizadas mediante el software IDM SPSS Statistics® y en planilla Excel® de forma cuantitativa. RESULTADOS: 152 alumnos respondieron la encuesta (15,2% del total), siendo el 49,4% de estos vegetariano. El 32,4% inició este patrón alimentario entre los 12-18 años; sus motivaciones más frecuentes fueron las medio ambientalistas (91,9%) y animalistas (72,9%). El 52,9% de los vegetarianos reciben suplementación de vitamina b 12 pero solo un 15,9% reportó presentar este déficit. El 75,7% obtiene información relacionada acerca de las dietas vegetarianas a través de medios digitales. CONCLUSIÓN: Se encontró un alto porcentaje de estudiantes vegetarianos en las encuestas contestadas, lo que hace necesario que los profesionales de salud estén capacitados en esta área para asegurar una adecuada educación nutricional, suplementación si es necesario, y seguimiento.

INTRODUCTION: There has been an increase in the popularity of vegetarian diets, especially among adolescents and young adults. These diets seem to be healthy and balanced, but the recommendations are contro versial regarding potential nutritional deficits. OBJECTIVE: To identify the frequency and types of ve getarian diet used, their motivation, and sources of information. PATIENTS AND METHOD: Cross-sec tional analytical study in freshmen students from the Pontifical Catholic University of Chile (PUC). Through an online survey, we collected demographic information and diet characterization of those who considered themselves as vegetarians. Variables were analyzed using IDM SPSS Statistics® soft ware and in Excel® spreadsheet in a quantitative way. RESULTS: 152 students answered the survey (15.2% of the sample) and, out of these, 49.4% were vegetarian. 32.4% started this eating pattern bet ween the ages 12 and 18 and among their most frequent motivations were environmentalists (91.9%) and animalists (72.9%). 52.9% of vegetarians take vitamin B 12 supplementation but only 15.9% reported having this deficiency. 75.7% obtain information related to vegetarian diets through digital media. CONCLUSION: In the surveys answered, we found a high percentage of vegetarian students, the refore, health professionals need to be trained in this area to assure adequate nutritional education, supplementation if necessary, and follow-up.

B Vitamins and One-Carbon Metabolism: Implications in Human Health and Disease.

Vitamins B9 (folate) and B12 are essential water-soluble vitamins that play a crucial role in the maintenance of one-carbon metabolism: a set of interconnected biochemical pathways driven by folate and methionine to generate methyl groups for use in DNA synthesis, amino acid homeostasis, antioxidant generation, and epigenetic regulation. Dietary deficiencies in B9 and B12, or genetic polymorphisms that influence the activity of enzymes involved in the folate or methionine cycles, are known to cause developmental defects, impair cognitive function, or block normal blood production. Nutritional deficiencies have historically been treated with dietary supplementation or high-dose parenteral administration that can reverse symptoms in the majority of cases. Elevated levels of these vitamins have more recently been shown to correlate with immune dysfunction, cancer, and increased mortality. Therapies that specifically target one-carbon metabolism are therefore currently being explored for the treatment of immune disorders and cancer. In this review, we will highlight recent studies aimed at elucidating the role of folate, B12, and methionine in one-carbon metabolism during normal cellular processes and in the context of disease progression.

Vegetarian diets in first year university students. / Dietas vegetarianas en alumnos universitarios.

INTRODUCTION: There has been an increase in the popularity of vegetarian diets, especially among adolescents and young adults. These diets seem to be healthy and balanced, but the recommendations are contro versial regarding potential nutritional deficits. OBJECTIVE: To identify the frequency and types of ve getarian diet used, their motivation, and sources of information. PATIENTS AND METHOD: Cross-sec tional analytical study in freshmen students from the Pontifical Catholic University of Chile (PUC). Through an online survey, we collected demographic information and diet characterization of those who considered themselves as vegetarians. Variables were analyzed using IDM SPSS Statistics® soft ware and in Excel® spreadsheet in a quantitative way. RESULTS: 152 students answered the survey (15.2% of the sample) and, out of these, 49.4% were vegetarian. 32.4% started this eating pattern bet ween the ages 12 and 18 and among their most frequent motivations were environmentalists (91.9%) and animalists (72.9%). 52.9% of vegetarians take vitamin B 12 supplementation but only 15.9% reported having this deficiency. 75.7% obtain information related to vegetarian diets through digital media. CONCLUSION: In the surveys answered, we found a high percentage of vegetarian students, the refore, health professionals need to be trained in this area to assure adequate nutritional education, supplementation if necessary, and follow-up.

Qualidade nutricional de dietas e estado nutricional de vegetarianos de municípios do centro oeste paulista / Nutritional quality of diets and nutritional status of vegetarians from cities of the midwest region of São Paulo / Calidade nutricional de las dietas y estado nutricional de los vegetarianos de municipios del oeste de São Paulo

Introdução: A Sociedade Vegetariana Brasileira considera vegetariano aquele que exclui de sua alimentação todos os tipos de carne, aves, peixes e seus derivados, podendo ou não utilizar laticínios ou ovos. Vegetarianismo inclui o veganismo, prática de não utilizar produtos oriundos do reino animal para quaisquer fins. Diversas razões justificam o crescimento dessas dietas na atualidade - questões ligadas aos direitos dos animais, à ética, ao meio ambiente, à religião, entre outras. Objetivos: Identificar os riscos e benefícios associados à restrição alimentar presente na dieta vegetariana através das quantidades diárias de proteínas, vitamina B12, ferro e cálcio; determinar o índice de massa corporal dos voluntários, sua frequência alimentar, estado nutricional, tempo de prática da dieta, acompanhamento nutricional, suplementação e motivos e benefícios associados. Material e Método: Trata-se de um estudo transversal descritivo quali-quantitativo realizado por meio da aplicação de questionários. Resultados: As deficiências nutricionais predominantes foram as de vitamina B12 e cálcio, especialmente nos adeptos do vegetarianismo estrito. Além disso, uma tendência ao sobrepeso foi observada na população estudada, estando relacionada ao maior consumo de alimentos industrializados e ultraprocessados. Conclusão: Recomenda-se atenção especial a alimentos contendo proteínas, vitamina B12, ferro e cálcio no planejamento da alimentação dos adeptos ao vegetarianismo, sobretudo os adeptos ao vegetarianismo estrito.(AU)

Introduction: The Brazilian Vegetarian Society considers vegetarian who excludes all types of meat, poultry, fish and their derivatives from their diet, whether or not they can use dairy products or eggs. Vegetarianism includes veganism, the practice of not using products from the animal kingdom for any purpose. Several reasons justify the growth of these diets today - issues related to animal rights, ethics, the environment, religion, among others. Objectives: To identify the risks and benefits associated with the dietary restriction present in the vegetarian diet through the daily amounts of proteins, vitamin B12, iron and calcium; to determine the volunteers' body mass index, their food frequency, nutritional status, time on the diet, nutritional monitoring, supplementation and associated reasons and benefits. Material and Method: This is a cross-sectional qualitative and quantitative study carried out through the application of questionnaires. Results: The predominant nutritional deficiencies were those of vitamin B12 and calcium, especially in adherents of strict vegetarianism. In addition, a tendency to overweight was observed in the studied population, being related to the higher consumption of processed and ultra-processed foods. Conclusion: Special attention is recommended to foods containing proteins, vitamin B12, iron and calcium when planning food for those who adhere to vegetarianism, especially those who adhere to strict vegetarianism.(AU)

Introducción: La Sociedad Vegetariana Brasileña considera a los vegetarianos que excluyen todos los tipos de carne, pollo, pescado y sus derivados de su dieta, ya sea que puedan o no usar productos lácteos o huevos. El vegetarianismo incluye el veganismo, la práctica de no usar productos del reino animal para ningún propósito. Varias razones justifican el crecimiento de estas dietas hoy en día: cuestiones relacionadas con los derechos de los animales, la ética, el medio ambiente, la religión, entre otros. Objetivos: Identificar los riesgos y beneficios asociados con la restricción dietética presente en la dieta vegetariana a través de las cantidades diarias de proteínas, vitamina B12, hierro y calcio; determinar el indice de masa corporal de los voluntarios, su frecuencia de alimentos, estado nutricional, tiempo en la dieta, seguimiento con un nutricionista, suplementos y razones y beneficios asociados. Material y Método: Estudio transversal cualitativo y cuantitativo realizado mediante la aplicación de cuestionarios. Resultados: Las deficiencias nutricionales predominantes fueron las de vitamina B12 y calcio, especialmente en adherentes del vegetarianismo estricto. Además, se observó una tendencia al sobrepeso en la población estudiada, relacionada con el mayor consumo de alimentos procesados y ultraprocesados. Conclusión: Se recomienda prestar especial atención a los alimentos que contienen proteínas, vitamina B12, hierro y calcio al planificar los alimentos para aquellos que se adhieren al vegetarianismo, especialmente aquellos que se adhieren al vegetarianismo estricto.(AU)

A meta-analysis of comparison of proximal gastrectomy with double-tract reconstruction and total gastrectomy for proximal early gastric cancer.

BACKGROUND: In theory, proximal gastrectomy with double-tract reconstruction (PG-DT) was superior to total gastrectomy (TG) in hematologic and nutritional outcomes. However, its clinical effects in proximal early gastric cancer (EGC) have been controversial. METHODS: The purpose of this study was to investigate the outcomes of laparoscopic proximal gastrectomy with double-tract reconstruction (LPG-DT) for proximal EGC. For this systematic review and meta-analysis, we searched for articles published before December of 2018 in the following databases: PubMed, Web of Science, EBSCO, Medline, and Cochrane Library. RESULTS: The results showed no significant difference in the anastomotic stenosis (OR = 0.91, 95%CI = 0.33-2.50, p = 0.85) and reflux esophagitis (OR = 1.87, 95%CI = 0.62-5.65, p = 0.27) between LPG-DT and laparoscopic total gastrectomy (LTG). The vitamin B12 supplementation rate in the LPG-DT group was lower than the LTG group (OR = 0.06, 95%Cl = 0.01-0.59, p = 0.02). CONCLUSIONS: Due to comparable clinical effect, PG-DT is comparable to TG for patients with proximal EGC. In addition, LPG-DT not only appears superior to TG in terms of preventing vitamin B12 deficiency, but also does not increase the risk of anastomotic stricture and reflux esophagitis.

[An exploratory study of vegetarianism in catering establishment]. / Estudio exploratorio del vegetarianismo en restauración colectiva.

INTRODUCTION: Introduction: interest in vegetarian diets is rising, however, it remains a very controversial topic, and with many reservations regarding it. Questions like their conceivable nutritional deficiencies, or if they are adequate or healthy, might be widely unknown. Objectives: exploring vegetarian diets, examining the current level of knowledge about them, and analyzing and improving, from a nutritional standpoint, the vegetarian menus of a restaurant with vegetarian options. Methods: this study was designed as an exploratory, crossover, descriptive study. Surveys with 17 items and a food frequency questionnaire were given among the customers of the restaurant. A total of 155 people, aged between 18 and 62, took part in it. A total of 30 menus were analyzed, and some suggestions were made in order to improve them. Results: out of the total sample, 138 people were omnivores, 12 people were vegetarians and two were vegans. More than half of the vegetarians did not know vitamin B12 is the only required supplement by default, and almost 60% of them stated never taking B12 supplements. The vegetarian menus which were analyzed provided a mean of 1,195 kcal, and covered 89% of the requirements of fiber, 212% of vitamin C, ≈30% of both calcium and zinc, 86% of iron, and 38% of B12. Conclusion: a great lack of knowledge regarding several aspects of vegetarian diets was found, even among vegetarian themselves. Informing the general public is essential for both avoiding dangerous nutritional deficiencies (like B12), and attracting more people towards this kind of diets, with all the benefits this would provide. In the vegetarian menus of Foodtopía, adequate levels of nutrients were observed. The main suggestions to improve the menus were: reducing the total calories and the amount of sunflower oil, and increasing the amount of legumes, nuts and seeds.

INTRODUCCIÓN: Introducción: el interés por las dietas vegetarianas está en auge, pero siguen existiendo muchas dudas y controversia al respecto. Temas como sus posibles deficiencias nutricionales, o si son adecuadas o saludables, podrían no ser ampliamente conocidos. Objetivos: explorar estas dietas, ver el nivel de conocimiento que existe sobre ellas y analizar y mejorar nutricionalmente los menús vegetarianos de un restaurante con opciones vegetarianas. Métodos: el diseño del estudio fue de tipo descriptivo, transversal y exploratorio. Se entregaron cuestionarios con 17 preguntas y un cuestionario de frecuencia de consumo de alimentos entre los clientes del restaurante. Participaron un total de 155 personas, con un rango de edad de 18-62 años. Se analizaron un total de 30 menús y se hicieron sugerencias para mejorarlos. Resultados: de la muestra total, 138 personas eran omnívoras, 12 eran vegetarianas y dos, veganas. Más de la mitad de los vegetarianos no sabían que la única suplementación necesaria por defecto es la B12 y el ≈60% de ellos dijo no suplementarse nunca con ella. Los menús vegetarianos analizados aportaban de media 1.195 kcal y cubrían el 89% de la ingesta recomendada de fibra, el 212% de vitamina C, ≈30% de calcio y zinc, el 86% de hierro y el 38% de B12. Se observaron niveles insuficientes de vitamina D. Conclusiones: existe un gran desconocimiento sobre muchos aspectos de las dietas vegetarianas, incluso entre los propios vegetarianos. Informar al público es primordial, tanto para evitar deficiencias nutricionales potencialmente peligrosas (B12), como para atraer a más personas hacia este tipo de dietas, con los beneficios que esto acarrearía. Se observaron niveles muy adecuados de nutrientes en los menús vegetarianos de Foodtopía. Las principales sugerencias de mejora fueron: reducir las calorías totales y la cantidad de aceite de girasol y aumentar la cantidad de legumbres, frutos secos y semillas.

Effects of maternal B12 supplementation on neurophysiological outcomes in children: a study protocol for an extended follow-up from a placebo randomised control trial in Bangalore, India.

INTRODUCTION: Vitamin B12 deficiency is highly prevalent in pregnant Indian women. Neuropsychological tests have shown an association between low maternal vitamin B12 status and poorer cognitive performances in the offspring, although findings from these studies have been inconsistent. Vitamin B12 has an important role in the formation of myelin which is important for the transmission speed of neural impulses and myelination in the central nervous system has been linked to cognition. Assessing neurophysiological measures using event-related potentials (ERPs) in children may provide additional information on the effect of maternal vitamin B12 supplementation on offspring brain function. The study examines the effects of oral vitamin B12 daily supplements (50 µg) to pregnant Indian women on child neurophysiological function at 72 months. METHODS AND ANALYSIS: We previously conducted a double-blind, placebo-controlled study to examine the effects of maternal vitamin B12 supplementation on cognitive outcomes in their offspring using the Bayley scales of infant development, third edition. In this extended follow-up of the same cohort of mother-child dyad, we propose to use ERP to study the long-term impact of maternal B12 supplementation on brain function in children at 72 months of age. We intend to use P300 and mismatch negativity (MMN) as measures of neurophysiological outcomes. The primary outcome of this study will be child neurophysiological measures (as measured by amplitude and latency of P300 and MMN) assessed at 72 months of age in children whose mothers received vitamin B12 compared with neurophysiological status of children whose mothers received placebo. ETHICS AND DISSEMINATION: The study was approved by the Institutional Ethical Board of St. John's Medical College and the Harvard School of Public Health Human Subjects Committee. Results obtained will be presented at national and international research meetings and published in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT00641862.

Vitamin B12-fortified toothpaste improves vitamin status in elderly people: a randomized, double-blind, placebo-controlled study.

BACKGROUND: Elderly people are at risk for vitamin B12 deficiency. AIMS: We studied the ability of vitamin B12-enriched toothpaste vs. placebo to increase vitamin B12 status in elderly subjects. METHODS: We conducted a randomized double-blind placebo-controlled intervention in 103 elderly subjects. Serum concentrations of vitamin B12, holotranscobalamin (holoTC), methylmalonic acid (MMA), and plasma total homocysteine (tHcy) were measured at baseline and after 3 months. RESULTS: 92 subjects met the inclusion criteria, completed the 3 months study, and were included in the data analysis. After the intervention, concentrations of vitamin B12 were higher [mean (SD) = 368 (123) vs. 295 (123) pmol/L; p = 0.005] and holoTC tended to be higher [112 (48) vs. 91 (68) pmol/L; p = 0.088] in the vitamin B12 group compared with the placebo group. The changes of serum vitamin B12 [54 (74) vs. 3 (60) pmol/L, p < 0.001], holoTC [21 (34) vs. 2 (32) pmol/L, p = 0.007], and tHcy [- 0.9 (2.3) vs. 0.3 (1.9) µmol/L, p = 0.010] were significantly different between the intervention groups. Mean percentage increase of serum vitamin B12 (+ 23% corresponds to + 54 pmol/L) in the vitamin B12 toothpaste group suggests that the intervention had provided an additional daily intake of approximately + 7 µg oral B12. Common diseases and drugs did not predict the change of blood markers in the vitamin group. No side effects were observed. CONCLUSIONS: The toothpaste enriched with 100 µg cyanocobalamin/g has increased vitamin B12 status and can thus be used for preventing vitamin B12 depletion in elderly people. The trial was registered at ClinicalTrials.gov: NCT02679833.

Safety of Same-Day Vitamin B12 Supplementation in Patients Receiving Pemetrexed for the Treatment of Non-Small-Cell Lung Cancer or Pleural Mesothelioma: A Retrospective Analysis.

BACKGROUND: Pemetrexed is a folate analog inhibitor for the treatment of non-small-cell lung cancer (NSCLC) and malignant pleural mesothelioma. Folic acid and vitamin B12 supplementation before initiating pemetrexed is necessary because of high rates of cytopenias without supplementation. However, the timing of supplementation has not been thoroughly investigated. PATIENTS AND METHODS: This was a single-center, retrospective study investigating patients receiving pemetrexed from January 1, 2012, to June 30, 2015, who received same-day vitamin B12 supplementation versus ≥ 1 day before pemetrexed. The objective was to evaluate safety outcomes in patients who received vitamin B12 on the same day as pemetrexed (group A) versus vitamin B12 ≥ 1 day (group B) before pemetrexed. RESULTS: Two hundred eighty-one patients met the inclusion criteria: 137 patients in group A (same-day administration of vitamin B12) and 144 patients in group B (median time of vitamin B12 administration before pemetrexed, 7 days; range, 1-42 days). Mean changes in hematologic indices from cycle (C) 1 to C2 or C2 to C3 did not differ significantly between groups. There were no significant differences in clinical events between C1 and C2 or C2 and C3 requiring supportive care. There was a significant difference noted in treatment delay in C3 [28/114 (24.6%) group A vs. 14/118 (11.9%) group B, P = .0164]. In group A, significant predictors of delay in C3 were baseline hemoglobin (mean 13.3 g/dL vs. 12.4 g/dL, P = .0137) and ANC (mean 6 × 109/L vs. 5 × 109/L, P = .0003). CONCLUSION: Same-day vitamin B12 and pemetrexed administration is a safe practice in NSCLC and malignant pleural mesothelioma patients.

Anemia following Roux-en-Y gastric bypass for morbid obesity; a 5-year follow-up study.

OBJECTIVES: Patients are at risk of anemia post Roux-en-Y gastric bypass (RYGB). We sought to determine the prevalence of anemia and related nutritional deficiencies 5 years after RYGB and to evaluate adherence to nutritional supplements with iron, vitamin B12, and folate. MATERIAL AND METHODS: Patients operated with RYGB 2004-2006 were eligible for evaluation. Blood samples were collected and use of nutritional supplements was recorded preoperatively, and at outpatients' consultations 1, 2, and 5 years postoperatively. Of 203 patients operated, 184 (91%) completed the 5 year follow-up and were included in the study. Of these, 97% had valid measurements of hemoglobin both at baseline and after 5 years. RESULTS: During the 5 years after RYGB, the prevalence of anemia increased from 4% preoperatively to 24% in females, and from 0% to 7% in males. Ferritin levels decreased gradually in both genders. Iron deficiency increased from 6% preoperatively to 42% at 5 years in females, and from 0% to 9% in males. Vitamin B12 deficiency was not altered while folate deficiency decreased from 10% preoperatively to 1% at 5 years. Five years after surgery 25% reported the use of supplements with iron, while 83% used vitamin B12 and 65% used multivitamins with folate. CONCLUSIONS: We observed a long-term increase in anemia and iron deficiency after RYGB in both genders, but most pronounced in women. Our postoperative protocol for prevention of vitamin B12 and folate deficiencies appear acceptable. Iron status and iron supplementation seems to need stronger emphasis during follow-up after RYGB.

Efficacy of oral compared with intramuscular vitamin B-12 supplementation after Roux-en-Y gastric bypass: a randomized controlled trial.

Background: After Roux-en-Y gastric bypass (RYGB), patients often develop a vitamin B-12 deficiency. Objective: Our objective was to investigate whether oral supplementation increases and normalizes low vitamin B-12 concentrations (vitamin B-12 > 200 pmol/L) in RYGB patients as compared to intramuscular injections. Design: A randomized controlled trial in RYGB patients with subnormal serum B-12 concentrations was performed. One group (IM B-12) received bimonthly intramuscular hydroxocobalamin injections (2000 µg as loading dose and 1000 µg at follow-up) for 6 mo. The second group (oral B-12) received daily doses of oral methylcobalamin (1000 µg). Serum vitamin B-12 was determined at baseline (T0) and at 2 (T1), 4 (T2), and 6 mo (T3) after start of treatment. Concentrations of the secondary markers methylmalonic acid (MMA) and homocysteine (Hcy) were measured at T0 and T3. Results: Fifty patients were included and randomized, 27 in IM B-12 and 23 in oral B-12. The median vitamin B-12 concentration at T0 was 175 pmol/L (range: 114-196 pmol/L) for IM B-12 and 167 pmol/L (range: 129-199 pmol/L) for oral B-12. Vitamin B-12 normalized in all individuals, and there was no significant difference in vitamin B-12 between the two groups. MMA and Hcy concentrations decreased significantly after 6 mo within each group (P < 0.001 and P < 0.001 for MMA and P = 0.03 and P = 0.045 for Hcy, respectively). There was no significant difference between the groups at 6 mo for both MMA and Hcy (P = 0.53 and P = 0.79). Conclusion: The efficacy of oral vitamin B-12 supplementation was similar to that of hydroxocobalamin injections in the present study. Oral supplementation can be used as an alternative to hydroxocobalamin injections to treat RYGB patients with low values of serum vitamin B-12. This trial was registered at clinicaltrials.gov as NCT02270749.

Voluntary fortification is ineffective to maintain the vitamin B12 and folate status of older Irish adults: evidence from the Irish Longitudinal Study on Ageing (TILDA).

Mandatory fortification of staple grains with folic acid and/or vitamin B12 (B12) is under debate in many countries including Ireland, which has a liberal, but voluntary, fortification policy. Older adults can be at risk of both deficiency and high folate status, although little is known on the actual prevalence and the major predictors. Population prevalence estimates from older adults (n 5290 ≥50 years) from the Irish Longitudinal Study on Ageing (TILDA) (Wave 1) are presented here. Measures included plasma total vitamin B12 and folate, whereas predictors included detailed demographic, socio-economic, geographic, seasonal and health/lifestyle data. The prevalence of deficient or low B12 status (45 nmol/l) was observed in 8·9 %, whereas high B12 status was observed in 3·1 % (>601 pmol/l). The largest positive predictor of B12 concentration was self-reported B12 injection and/or supplement use (coefficient 51·5 pmol/; 95 % CI 9·4, 93·6; P=0·016) followed by sex and geographic location. The largest negative predictor was metformin use (-33·6; 95 % CI -51·9, -15·4; P<0·0001). The largest positive predictor of folate concentration was folic acid supplement use (6·0; 95 % CI 3·0, 9·0 nmol/l; P<0·001) followed by being female and statin medications. The largest negative predictor was geographic location (-5·7; 95 % CI -6·7, -4·6; P<0·0001) followed by seasonality and smoking. B-vitamin status in older adults is affected by health and lifestyle, medication, sampling period and geographic location. We observed a high prevalence of low B12 and folate status, indicating that the current policy of voluntary fortification is ineffective for older adults.

Do specialized bariatric multivitamins lower deficiencies after RYGB?

BACKGROUND: One of the side effects of bariatric surgery is the risk of vitamin and mineral deficiencies. Vitamin B12, vitamin D, folate, and iron deficiencies are especially common among Roux-en-Y gastric bypass patients. OBJECTIVE: To examine the effectiveness of a specialized multivitamin supplement for Roux-en-Y gastric bypass patients on deficiencies the first 3 years postoperatively, retrospectively in a large, prospectively collected cohort. SETTING: Large specialized bariatric hospital. RESULTS: One thousand one hundred sixty patients were included, 883 users and 258 who were nonusers of the specialized multivitamin. Patient characteristics and total weight were comparable. Higher serum concentrations of ferritin (124.7 ± 96.2 µg/L versus 106.0 ± 83.0 µg/L, P = .016), vitamin B12 (347.3 ± 145.1 pmol/L versus 276.8 ± 131.4 pmol/L, P<.001), folic acid (34.9 ± 9.6 nmol/L versus 25.4 ± 10.7 nmol/L, P<.001), and vitamin D (98.4 ± 28.7 nmol/L versus 90.0 ± 34.5 nmol/L, P = .002) were observed in users compared with nonusers after 1 year. Less new deficiencies were found for ferritin (1% versus 4%, P = .029), vitamin B12 (9% versus 23%, P<.001), and vitamin D (0% versus 4%, P<.001) in users compared with nonusers. Two and 3 years after the surgery these findings remained almost identical. CONCLUSIONS: The use of specialized multivitamin supplements resulted in less deficiencies of vitamin B12, vitamin D, folic acid, and ferritin. The study showed that Roux-en-Y gastric bypass patients benefited from the specialized multivitamin supplements and it should be advised to this patient group.

Oral Vitamin B12 Supplementation After Roux-en-Y Gastric Bypass: a Systematic Review.

BACKGROUND: Many respectable guidelines recommend lifelong vitamin B12 injections for Roux-en-Y gastric bypass (RYGB) patients in the absence of lack of consensus on the efficacy of oral route of prophylaxis and the appropriate doses needed for this purpose. The purpose of this review was to examine the published English language scientific literature in accordance with PRISMA principles to find out if orally given vitamin B12 is adequate for prophylactic purposes in RYGB patients and the appropriate dosages needed for this purpose if it is. METHODS: We examined the PubMed database for all English language articles examining various doses of oral vitamin B12 supplementation after proximal RYGB in adult patients. The search revealed 19 such articles. RESULTS: The data suggest that oral vitamin B12 supplementation doses of ≤ 15 µg daily are insufficient to prevent deficiency in RYGB patients. Higher supplementation doses show better results and it appears that a dose of 600.0 µg vitamin B12 daily is superior to 350.0 µg daily suggesting an incremental dose-response curve. It further appears that supplementation doses of 1000.0 µg vitamin B12 daily lead to an increase in B12 levels and are sufficient for the prevention of its deficiency in most RYGB patients. CONCLUSION: The review finds that oral supplementation doses of ≤ 15 µg vitamin B12 daily are inadequate for prophylaxis of vitamin B12 deficiency in adult RYGB patients but doses of 1000 µg vitamin B12 daily might be adequate. Future studies need to examine this and even higher oral doses for vitamin B12 supplementation for patients undergoing RYGB.