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

被引:116
作者
Bailey, Regan L. [1 ]
Carmel, Ralph [2 ,3 ]
Green, Ralph [4 ]
Pfeiffer, Christine M. [5 ]
Cogswell, Mary E. [6 ]
Osterloh, John D. [5 ]
Sempos, Christopher T. [1 ]
Yetley, Elizabeth A. [1 ]
机构
[1] NIH, Off Dietary Supplements, Bethesda, MD 20892 USA
[2] New York Methodist Hosp, Dept Med, Brooklyn, NY USA
[3] Cornell Univ, Weill Med Coll, New York, NY 10021 USA
[4] Univ Calif Davis, Med Ctr, Dept Pathol & Lab Med, Sacramento, CA 95817 USA
[5] Ctr Dis Control & Prevent, Natl Ctr Environm Hlth, Atlanta, GA USA
[6] Ctr Dis Control & Prevent, Natl Ctr Chron Dis Prevent & Hlth Promot, Atlanta, GA USA
关键词
COBALAMIN DEFICIENCY; TOTAL HOMOCYSTEINE; NATIONAL-HEALTH; BIOCHEMICAL INDICATORS; COGNITIVE IMPAIRMENT; FOLATE; POPULATION; PREVALENCE; DIAGNOSIS; ANEMIA;
D O I
10.3945/ajcn.111.015222
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
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. Am J Clin Nutr 2011;94:552-61.
引用
收藏
页码:552 / 561
页数:10
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