Advertisement

Symptomatic dietary vitamin B12 deficiency in a nonvegetarian population

      Vitamin B12 (cobalamin) is an essential nutrient that must be supplied by dietary meat or dairy products, with a minimum recommended daily intake of 2 to 4 μg in men and women (
      • Babior B.M
      • Bunn H.F
      Megaloblastic anemias.
      ,
      • Snow C.F
      Laboratory diagnosis of vitamin B12 and folate deficiency.
      ). Body stores contain 4 to 5 mg of cobalamin; thus it takes 3 to 6 years until vitamin deficiency becomes clinically evident, with hematologic or neuropsychiatric abnormalities. The most common cause of cobalamin deficiency is malabsorption, such as in pernicious anemia, which is estimated to affect 0.1% of the general population and up to 1% of the older population (
      • Snow C.F
      Laboratory diagnosis of vitamin B12 and folate deficiency.
      ). Nutritional vitamin B12 deficiency is a rare cause of hematologic and neurologic abnormalities in young nonvegetarian persons (
      • Narayanan M.N
      • Dawson D.W
      • Lewis M.J
      Dietary deficiency of vitamin B12 is associated with low serum cobalamin levels in nonvegetarians.
      ). We report the findings of a study of urban Bedouin patients, who had been seen by their primary care physicians for various nonspecific complaints, in whom information was collected on dietary habits and serum cobalamin levels were measured.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Babior B.M
        • Bunn H.F
        Megaloblastic anemias.
        in: Fauci A.S Braunwald E Isselbacher K.J Harrison’s Principles of Internal Medicine. 14th ed. McGraw-Hill, New York, New York1988: 1523-1529
        • Snow C.F
        Laboratory diagnosis of vitamin B12 and folate deficiency.
        Arch Intern Med. 1999; 159: 1289-1298
        • Narayanan M.N
        • Dawson D.W
        • Lewis M.J
        Dietary deficiency of vitamin B12 is associated with low serum cobalamin levels in nonvegetarians.
        Eur J Haematol. 1991; 47: 115-118
        • Hash R.B
        • Sargent M.A
        • Katner H
        Anemia secondary to combined deficiencies of iron and cobalamin.
        Arch Fam Med. 1996; 5: 585-588
        • Spivak J.L
        Masked megaloblastic anemia.
        Arch Intern Med. 1982; 142: 2111-2114
        • Carmel R
        • Karnaza D.S
        Physician response to low serum cobalamin levels.
        Arch Intern Med. 1986; 146: 1161-1165
        • Oakly Jr, G.P
        Let’s increase folic acid fortification and include vitamin B12.
        Am J Clin Nutr. 1997; 65: 1889-1990
        • Mueller J.F
        • Will J.J
        Interrelationship of folic acid, vitamin B12 and ascorbic acid in patients with megaloblastic anemia.
        Am J Clin Nutr. 1955; 3: 34
        • Brantigan C.O
        Folate supplementation and the risk of masking vitamin B12 deficiency.
        JAMA. 1997; 277: 880
        • Lindenbaum J
        • Healton E.B
        • Savage D.G
        • et al.
        Neuropsychiatric disorders caused by cobalamin deficiency in the absence of anemia or macrocytosis.
        N Engl J Med. 1988; 318: 1720-1728
        • Hutton B.R
        Folate and cobalamin in psychiatric illness.
        Compr Psychiatry. 1997; 38: 305-314
        • Healton E.B
        • Savage D.G
        • Brust J.C.M
        • et al.
        Neurologic aspects of cobalamin deficiency.
        Medicine. 1991; 70: 229-245
        • Miller H.L
        • Golden R.N
        • Evans D.L
        Mental dysfunction and cobalamin deficiency.
        Arch Intern Med. 1990; 150: 910-911
        • Evans D.L
        • Edelsohn G.A
        • Golden R.N
        Organic psychosis without anemia or spinal cord symptoms in patients with vitamin B12 deficiency.
        Am J Psychiatry. 1983; 140: 218-221
        • Machar D.B
        • McCrory D.C
        • Millington D.S
        • Feussner J.R
        Performance of the serum cobalamin assay for diagnosis of cobalamin deficiency.
        Am J Med Sci. 1994; 308: 276-283
        • Lindenbaum J
        • Savage D.G
        • Stabler S.P
        • et al.
        Diagnosis of cobalamin deficiency. II.
        Am J Hematol. 1990; 34: 99-107
        • Stabler S.P
        • Allen R.H
        • Savage D.G
        • Lindenbaum J
        Clinical spectrum and diagnosis of cobalamin deficiency.
        Blood. 1990; 76: 871-881
        • Penland J.G
        • Allen L.H
        • Boy E
        • et al.
        Adaptive functioning, behavior problems and school performance of Guatemalan children with deficient, marginal and normal plasma vitamin B-12.
        FASEB J. 2000; 14: A561
        • Lederle F.A
        Oral cobalamin for pernicious anemia.
        JAMA. 1991; 265: 94-95
        • Matthews J.H
        • Clark D.M
        • Abrahamson G.M
        Effect of therapy with vitamin B12 and folic acid on elderly patients with low concentration of serum vitamin B12 or erythrocyte folate but normal blood counts.
        Acta Haematol. 1988; 79: 84-87
        • Herbert V
        Recommended dietary intake (RDI) of vitamin B-12 in humans.
        Am J Clin Nutr. 1987; 45: 671-678
        • Czeizel A.E
        • Merthala Z
        Bread fortification with folic acid, vitamin B12 and vitamin B6 in Hungary.
        Lancet. 1998; 352: 1225