Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12

Regan L. Bailey, Ralph Carmel, Ralph Green, Christine M. Pfeiffer, Mary E. Cogswell, John D. Osterloh, Christopher T. Sempos, Elizabeth A. Yetley

Research output: Contribution to journalArticle

61 Citations (Scopus)

Abstract

Background: Various definitions, criteria, tests, and cutoffs have been used to define vitamin B-12 status; however, a need exists for the systematic study of vitamin B-12 status in the United States because of concerns about high folic acid intakes and the potential for associated adverse effects. Objective: The objective was to determine the effect of different cutoff choices on outcomes and of the different degrees of serum vitamin B-12 status, definable by the concurrent use of a functional and circulating marker as the first steps to developing a data-based consensus on the biochemical diagnosis of vitamin B-12 deficiency. Design: Data from NHANES, a nationally representative cross-sectional survey, were examined for adults aged >19 y (mean ±SD age: 45 ± 1 y) from 1999 to 2004 (n = 12,612). Results: Commonly used cutoffs had a greater effect on prevalence estimates of low vitamin B-12 status with the use of vitamin B-12 than with the use of methylmalonic acid (MMA; 3-26% and 2-6%, respectively). A cutoff of >148 pmol/L for vitamin B-12 and of ≤210 nmol/L for MMA resulted in significant misclassifications. Approximately 1% of adults had a clear vitamin B-12 deficiency (low vitamin B-12 and elevated MMA); 92% of adults had adequate vitamin B-12 status. A high percentage of younger women characterized the group with low vitamin B-12 and normal MMA (2% of adults) and may have falsely reflected low vitamin B-12. Adults with elevated MMA (5%) only were demographically similar (ie, by age and race) to the deficient group and may have included some individuals with early vitamin B-12 deficiency. Conclusions: These analyses indicate the challenges of assessing vitamin B-12 status when uncertainties exist about the appropriate cutoffs. Future studies should determine definable endpoints to achieve this goal.

Original languageEnglish (US)
Pages (from-to)552-561
Number of pages10
JournalAmerican Journal of Clinical Nutrition
Volume94
Issue number2
DOIs
StatePublished - Aug 1 2011

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Methylmalonic Acid
Vitamin B 12
Nutritional Status
Serum
Vitamin B 12 Deficiency
Nutrition Surveys
Folic Acid
Uncertainty

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

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Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12. / Bailey, Regan L.; Carmel, Ralph; Green, Ralph; Pfeiffer, Christine M.; Cogswell, Mary E.; Osterloh, John D.; Sempos, Christopher T.; Yetley, Elizabeth A.

In: American Journal of Clinical Nutrition, Vol. 94, No. 2, 01.08.2011, p. 552-561.

Research output: Contribution to journalArticle

Bailey, Regan L. ; Carmel, Ralph ; Green, Ralph ; Pfeiffer, Christine M. ; Cogswell, Mary E. ; Osterloh, John D. ; Sempos, Christopher T. ; Yetley, Elizabeth A. / Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12. In: American Journal of Clinical Nutrition. 2011 ; Vol. 94, No. 2. pp. 552-561.
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