The Indian Journal of Nutrition and Dietetics

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Vitamin B12 Status among Healthy Indian Population: A Review


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1 Institute of Home Economics, University of Delhi, Delhi - 110 039, India
     

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Vitamin B12 is a water-soluble micronutrient found in animal foods. Its deficiency is not uncommon in India owing to vegetarianism but often unrecognized due to diverse clinical manifestations, involving hematologic and behavioral and neurologic deterioration. The present review is to collate the current data on vitamin B12status among healthy Indian population. A total of 620 studies were identified using PubMed, out of which 40 studies that matched the selection criteria, were shortlisted and reviewed. The results highlight inadequate vitamin B12 status in most age groups, with the prevalence of deficiency reaching 100%, 78.5%, 61.7% and 75.4% in infants, children and adolescents, adults, elderly and pregnant women, respectively based on varying cut offs. However, due to variation in the biomarkers and cutoffs used for defining clinical and sub-clinical vitamin B12 deficiency and varied laboratory techniques used for analysis, direct comparison of the prevalence of deficiency in the studied population is difficult. Nevertheless, this review highlights that vitamin B12 deficiency is an emerging public health concern that requires further research involving dietary intake of vitamin B12 and serum levels in population groups in India to understand many aspects of vitamin B12 absorption, bioavailability and metabolism.

Keywords

Adult, Deficiency, Healthy, Indian, Infants, Prevalence, Pregnant, Vitamin B12.
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  • Institute of Medicine (US) Standing Committee on the Scientific Evaluation of Dietary Reference Intakes and its Panel on Folate, Other B Vitamins and Choline. Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Pantothenic Acid, Biotin and Choline. Washington (DC): National Academies Press (US), 1998. Available from: https://www.ncbi.nlm.nih.gov/books/NBK114310/doi: 10.17226/6015.

  • Ankar, A. and Bhimji, S.S. Vitamin B12 Deficiency (Cobalamin) [Updated 2018 Oct 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 Jan. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441923/

  • Kalita, J. and Misra, U.K. Benefit of vitamin B12 supplementation in asymptomatic elderly: a matter of endpoints. Am. J. Clin. Nutr., 2015, 102, 529-530.

  • Herrmann, W., Herrmann, M. and Obeid, R. Hyperhomocysteinaemia: a critical review of old and new aspects. Curr. Drug. Metab., 2007, 8, 17-31.

  • Conzade, R., Koenig, W., Heier, M., Schneider, A., Grill, E., Peters, A. and Thorand, B. Prevalence and predictors of subclinical micronutrient deficiency in German older adults: results from the population-based KORA-age study. Nutrients, 2017, 9.

  • Sucharita, S., Thomas, T., Sowmya, S., Krishnamachari, S., Kurpad, A.V. and Vaz, M. Subclinical vitamin B12 deficiency and heart rate variability across life cycle. Curr. Aging. Sci., 2016, 9, 217-223.

  • Issac, T.G., Soundarya, S., Christopher, R. and Chandra, S.R. Vitamin B12 deficiency: an important reversible co-morbidity in neuropsychiatric manifestations. Ind. J. Psychol. Med., 2015, 37, 26-29.

  • Yajnik, C.S., Deshpande, S.S., Lubree, H.G., Naik, S.S., Bhat, D.S., Uradey, B.S., Deshpande, J.A., Rege, S.S., Refsum, H. and Yudkin, J.S. Vitamin B12 deficiency and hyperhomocysteinemia in rural and urban Indians. J. Assoc. Physi. India., 2006, 54, 775-782.

  • Wadia, R.S., Bandishti, S. and Kharche, M. B12 and folate deficiency: incidence and clinical features. Neurol. India., 2000, 48, 302-304.

  • O’Leary, F. and Samman, S. Vitamin B12 in health and disease. Nutr., 2010, 2, 299-316.

  • Yetley, E.A., Pfeiffer, C.M., Phinney, K.W., Bailey, R.L., Blackmore, S., Bock, J.L., Brody, L.C., Carmel, R., Curtin, L.R., Durazo-Arvizu, R.A., Eckfeldt, J.H., Green, R., Gregory, J.F., Hoofnagle, A.N., Jacobsen, D.W., Jacques, P.F., Lacher, D.A., Molloy, A.M., Massaro, J., Mills, J.L., Nexo, E., Rader, J.I., Selhub, J., Sempos, C., Shane, B., Stabler, S., Stover, P., Tamura, T., Tedstone, A., Thorpe, S.J., Coates, P.M., Johnson, C.L. and Picciano, M.F. Biomarkers of vitamin B12 status in NHANES: a roundtable summary. Am. J. Clin. Nutr., 2011, 94, 313S-321S.

  • Hannibal, L., Lysne, V., Bjorke-Monsen, A.L., Behringer, S., Grunert, S.C., Spiekerkoetter, U., Jacobsen, D.W. and Blom, H. J. Biomarkers and algorithms for the diagnosis of vitamin B12 deficiency. Front. Mol. Biosci., 2016, 3, 27.

  • Hunt, A., Harrington, D. and Robinson, S. Vitamin B12 deficiency. BMJ., 2014, 348, 5226.

  • de Benoist, B. Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Fd. Nutr. Bull., 2008, 29, S238-S244.

  • Rizzo, G., Lagana, A.S., Rapisarda, A.M., La Ferrera, G.M., Buscema, M., Rossetti, P., Nigro, A., Muscia, V., Valenti, G., Sapia, F., Sarpietro, G., Zigarelli, M. and Vitale, S.G. Vitamin B12 among vegetarians: status, assessment and supplementation. Nutr., 2016, 8.

  • Devalia, V., Hamilton, M.S. and Molloy, A.M. Guidelines for the diagnosis and treatment of cobalamin and folate disorders. Br. J. Haematol., 2014, 166, 496-513.

  • Naik, S., Bhide, V., Babhulkar, A., Mahalle, N., Parab, S., Thakre, R. and Kulkarni, M. Daily milk intake improves vitamin B12 status in young vegetarian Indians: An intervention trial. Nutr. J., 2013, 12, 136.

  • Haroon, N.N., Marwaha, R.K., Godbole, M.M. and Gupta, S.K. Role of B12 and homocysteine status in determining BMD and bone turnover in young Indians. J. Clin. Densitom., 2012, 15, 366-373.

  • Refsum, H., Yajnik, C.S., Gadkari, M., Schneede, J., Vollset, S.E., Orning, L., Guttormsen, A.B., Joglekar, A., Sayyad, M.G., Ulvik, A. and Ueland, P.M. Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. Am. J. Clin. Nutr., 2001, 74, 233-241.

  • Herrmann, W., Schorr, H., Obeid, R. and Geisel, J. Vitamin B12 status, particularly holotranscobalamin II and methylmalonic acid concentrations, and hyperhomocysteinemia in vegetarians. Am. J. Clin. Nutr., 2003, 78, 131-136.

  • Herrmann, W., Obeid, R., Schorr, H. and Geisel, J. The usefulness of holotranscobalamin in predicting vitamin B12 status in different clinical settings. Curr. Drug. Metab., 2005, 6, 47-153.

  • Elmadfa, I. and Singer, I. Vitamin B12 and homocysteine status among vegetarians: A global perspective. Am. J. Clin. Nutr., 2009, 89, 1693s-1698s.

  • Waldmann, A., Koschizke, J.W., Leitzmann, C. and Hahn, A. German vegan study: diet, life-style factors, and cardiovascular risk profile. Ann. Nutr. Metab., 2005, 49, 366-72.

  • Kumar, T., Taneja, S., Yajnik, C.S., Bhandari, N. and Strand, T.A. Prevalence and predictors of anemia in a population of North Indian children. Nutr., 2014, 30, 531-357.

  • Heil, S.G., de Jonge, R., de Rotte, M.C., van Wijnen, M., Heiner-Fokkema, R.M., Kobold, A.C., Pekelharing, J.M., Adriaansen, H. J., Sanders, E., Trienekens, P.H., Rammeloo, T. and Lindemans, J. Screening for metabolic vitamin B12 deficiency by holotranscobalamin in patients suspected of vitamin B12 deficiency: a multicentre study. Ann. Clin. Biochem., 2012, 49, 184-189.

  • Sucharita, S., Dwarkanath, P., Thomas, T., Srinivasan, K., Kurpad, A.V. and Vaz, M. Low maternal vitamin B12 status during pregnancy is associated with reduced heart rate variability indices in young children. Matern. Child. Nutr., 2014, 10, 226-233.

  • Strand, T.A., Taneja, S., Bhandari, N., Refsum, H., Ueland, P.M., Gjessing, H.K., Bahl, R., Schneede, J., Bhan, M.K. and Sommerfelt, H. Folate, but not vitamin B-12 status, predicts respiratory morbidity in north Indian children., Am. J. Clin. Nutr., 2007, 86, 139-144.

  • Taneja, S., Bhandari, N., Strand, T.A., Sommerfelt, H., Refsum, H., Ueland, P.M., Schneede, J., Bahl, R. and Bhan, M.K. Cobalamin and folate status in infants and young children in a low-to-middle income community in India. Am. J. Clin. Nutr., 2007, 86, 1302-1309.

  • Chakraborty, S., Chopra, M., Mani, K., Giri, A.K., Banerjee, P., Sahni, N.S., Siddhu, A., Tandon, N. and Bharadwaj, D. Prevalence of vitamin B12 deficiency in healthy Indian school-going adolescents from rural and urban localities and its relationship with various anthropometric indices: a cross-sectional study. J. Hum. Nutr. Diet., 2018, 31, 513-522.

  • Osei, A., Houser, R., Bulusu, S., Joshi, T. and Hamer, D. Nutritional status of primary schoolchildren in Garhwali Himalayan villages of India. Fd. Nutr. Bull., 2010, 31, 221-233.

  • Bhardwaj, A., Kumar, D., Raina, S.K., Bansal, P., Bhushan, S. and Chander, V. Rapid assessment for coexistence of vitamin B12 and iron deficiency anemia among adolescent males and females in Northern Himalayan state of India. Anemia, 2013, 2013, 959605.

  • Dwarkanath, P., Barzilay, J.R., Thomas, T., Thomas, A., Bhat, S. and Kurpad, A.V. High folate and low vitamin B12 intakes during pregnancy are associated with small-forgestational age infants in South Indian women: a prospective observational cohort study. Am. J. Clin. Nutr., 2013, 98, 1450-1458.

  • Yajnik, C.S., Deshpande, S.S., Panchanadikar, A.V., Naik, S.S., Deshpande, J.A., Coyaji, K.J., Fall, C. and Refsum, H. Maternal total homocysteine concentration and neonatal size in India. Asia. Pac. J. Clin. Nutr., 2005, 14, 179-181.

  • Gadgil, M., Joshi, K., Pandit, A., Otiv, S., Joshi, R., Brenna, J.T. and Patwardhan, B. Imbalance of folic acid and vitamin B12 is associated with birth outcome: an Indian pregnant women study. Eur. J. Clin. Nutr., 2014, 68, 726-729.

  • Pathak, P., Kapil, U., Yajnik, C.S., Kapoor, S.K., Dwivedi, S.N. and Singh, R. Iron, folate and vitamin B12 stores among pregnant women in a rural area of Haryana State, India. Fd. Nutr. Bull., 28, 435-438.

  • Bhate, V., Deshpande, S., Bhat, D., Joshi, N., Ladkat, R., Watve, S., Fall, C., de Jager, C.A., Refsum, H. and Yajnik, C. Vitamin B12 status of pregnant Indian women and cognitive function in their 9-year-old children. Fd. Nutr. Bull., 2008, 29, 249-254.

  • Yajnik, C.S., Deshpande, S.S., Jackson, A.A., Refsum, H., Rao, S., Fisher, D.J., Bhat, D.S., Naik, S.S., Coyaji, K.J., Joglekar, C.V., Joshi, N., Lubree, H.G., Deshpande, V.U., Rege, S.S. and Fall, C.H. Vitamin B12 and folate concentrations during pregnancy and insulin resistance in the offspring: the Pune Maternal Nutrition Study. Diabetologia, 2008, 51, 29-38.

  • Lubree, H.G., Katre, P.A., Joshi, S.M., Bhat, D.S., Deshmukh, U.S., Memane, N.S., Otiv, S.R., Rush, E.C. and Yajnik, C.S. Child’s homocysteine concentration at 2 years is influenced by pregnancy vitamin B12and folate status. J. Dev. Orig. Health. Dis., 2012, 3, 32-38.

  • Muthayya, S., Dwarkanath, P., Mhaskar, M., Mhaskar, R., Thomas, A., Duggan, C., Fawzi, W.W., Bhat, S., Vaz, M. and Kurpad, A. The relationship of neonatal serum vitamin B12 status with birth weight. Asia. Pac. J. Clin. Nutr., 2006, 15, 538-543.

  • Bruinse, H.W. and van den Berg, H. Changes of some vitamin levels during and after normal pregnancy. Eur. J. Obstet. Gynecol. Reprod. Biol., 1995, 61, 31-37.

  • Koebnick, C., Heins, U.A., Dagnelie, P.C., Wickramasinghe, S.N., Ratnayaka, I.D., Hothorn, T., Pfahlbeg, A.B., Hoffmann, I., Lindemans, J. and Leitzmann, C. Longitudinal concentrations of vitamin B12 and vitamin B12 binding proteins during uncomplicated pregnancy. Clin. Chem., 2002, 48, 928–933.

  • Sucharita, S., Sowmya, S., Thomas, T., Kurpad, A.V. and Vaz, M. Plasma vitamin B12, methylmalonic acid and heart rate variability in healthy young Indian adults. Int. J. Vitam. Nutr. Res., 2013, 83, 147-153.

  • Agrawal, A., Ilango, K., Singh, P. K., Karmakar, D., Singh, G. P., Kumari, R. and Dubey, G. P. Age dependent levels of plasma homocysteine and cognitive performance. Behav. Brain. Res., 2015, 283, 139-144.

  • Gupta, E.S., Sheth, S.P. and Ganjiwale, J.D. Association of vitamin B12 deficiency and use of reverse osmosis processed water for drinking: A cross-sectional study from Western India. J. Clin. Diagn. Res., 2016, 10, 37-40.

  • Naik, S., Joglekar, C., Bhat, D., Lubree, H., Rege, S., Raut, K., Katre, P., Rush, E. and Yajnik, C. Marked gender difference in plasma total homocysteine concentrations in Indian adults with low vitamin B12. Int. J. Vitam. Nutr. Res., 2011, 31, 306-316.

  • Sivaprasad, M., Shalini, T., Balakrishna, N., Sudarshan, M., Lopamudra, P., Suryanarayana, P., Arlappa, N., Ravikumar, B.P., Radhika, M.S. and Reddy, G.B. Status of vitamin B12 and folate among the urban adult population in South India. Ann. Nutr. Metab., 2016, 68, 94-102.

  • Shobha, V., Tarey, S.D., Singh, R.G., Shetty, P., Unni, U.S., Srinivasan, K. and Kurpad, A.V. Vitamin B12 deficiency and levels of metabolites in an apparently normal urban south Indian elderly population. Ind. J. Med. Res., 2011, 134, 432-439.

  • Margalit, I., Cohen, E., Goldberg, E. and Krause, I. Vitamin B12 deficiency and the role of gender: A cross-sectional study of a large cohort. Ann. Nutr. Metab., 2018, 72, 265-271.

  • Allen, L.H. Vitamin B12 metabolism and status during pregnancy, lactation and infancy. Adv. Exp. Med. Biol., 1994, 352, 173-186.

  • Sukla, K.K., Tiwari, P.K., Kumar, A. and Raman, R. Low birth weight (LBW) and neonatal hyperbilirubinemia (NNH) in an Indian cohort: association of homocysteine, its metabolic pathway genes and micronutrients as risk factors. PLoS One., 2013, 8, e71587.

  • Mittal, M., Bansal, V., Jain, R. and Dabla, P.K. Perturbing status of vitamin B12 in Indian infants and their mothers. Fd. Nutr. Bull., 2017, 38, 209-215.

  • Strand, T.A., Taneja, S., Ueland, P.M., Refsum, H., Bahl, R., Schneede, J., Sommerfelt, H. and Bhandari, N. Cobalamin and folate status predicts mental development scores in North Indian children 12-18 mo of age. Am. J. Clin. Nutr., 2013, 97, 110-117.

  • Pasricha, S.R., Black, J., Muthayya, S., Shet, A., Bhat, V., Nagaraj, S., Prashanth, N.S., Sudarshan, H., Biggs, B.A. and Shet, A.S. Determinants of anemia among young children in rural India. Pediat, 2010, 126, 140-149.

  • Pasricha, S.R., Shet, A.S., Black, J.F., Sudarshan, H., Prashanth, N.S. and Biggs, B.A. Vitamin B12, folate, iron and vitamin A concentrations in rural Indian children are associated with continued breastfeeding, complementary diet and maternal nutrition. Am. J. Clin. Nutr., 2011, 94, 1358-1370.

  • Kapil, U., Toteja, G.S. and Bhadoria, A.S. Cobalamin and folate deficiencies among children in the age group of 12-59 months in India. Biomed. J., 2015, 38, 162-166.

  • Hanumante, N.M., Wadia, R.S., Deshpande, S.S., Sanwalka, N.J., Vaidya, M.V. and Khadilkar, A.V. Vitamin B12 and homocysteine status in asymptomatic Indian toddlers. Ind. J. Pediat., 2008, 75, 751-753.

  • Gupta, A., Kapil, U., Ramakrishnan, L., Pandey, R.M. and Yadav, C.P. Prevalence of vitamin B12 and folate deficiency in school children residing at high altitude regions in India. Ind. J. Pediat., 2017, 84, 289-293.

  • Christian, A.M., Krishnaveni, G.V., Kehoe, S.H., Veena, S.R., Khanum, R., Marley-Zagar, E., Edwards, P., Margetts, B.M. and Fall, C.H. Contribution of food sources to the vitamin B12 status of South Indian children from a birth cohort recruited in the city of Mysore. Public. Health. Nutr., 2015, 18, 596-609.

  • Veena, S.R., Krishnaveni, G.V., Srinivasan, K., Wills, A.K., Muthayya, S., Kurpad, A.V., Yajnik, C.S. and Fall, C.H. Higher maternal plasma folate but not vitamin B12 concentrations during pregnancy are associated with better cognitive function scores in 9- to 10- year-old children in South India. J. Nutr., 2010, 140, 1014-1022.

  • Kapil, U. and Bhadoria, A.S. Prevalence of folate, ferritin and cobalamin deficiencies amongst adolescent in India. J. Family. Med. Prim. Care., 2014, 3, 247-249.

  • Muthayya, S., Kurpad, A.V., Duggan, C.P., Bosch, R.J., Dwarkanath, P., Mhaskar, A., Mhaskar, R., Thomas, A., Vaz, M., Bhat, S. and Fawzi, W.W. Low maternal vitamin B12 status is associated with intrauterine growth retardation in urban South Indians. Eur. J. Clin. Nutr., 2006, 60, 591-801.

  • Samuel, T.M., Duggan, C., Thomas, T., Bosch, R., Rajendran, R., Virtanen, S.M., Srinivasan, K. and Kurpad, A. V. Vitamin B12 intake and status in early pregnancy among urban South Indian women. Ann. Nutr. Metab., 2013, 62, 113-122.

  • Krishnaveni, G.V., Hill, J.C., Veena, S.R., Bhat, D.S., Wills, A.K., Karat, C.L., Yajnik, C.S. and Fall, C.H. Low plasma vitamin B12 in pregnancy is associated with gestational ‘diabesity’ and later diabetes. Diabetologia, 2009, 52, 2350-2358.

  • Ingole, J.R., Patel, R.D., Ingole, S.J. and Pandave, H.T. Opportunistic screening of vitamin B12 deficiency in IT professionals presenting for routine health check-up. J. Clin. Diagn. Res., 2015, 9, 1-2.


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  • Vitamin B12 Status among Healthy Indian Population: A Review

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Authors

Anku Malik
Institute of Home Economics, University of Delhi, Delhi - 110 039, India
Geeta Trilok Kumar
Institute of Home Economics, University of Delhi, Delhi - 110 039, India

Abstract


Vitamin B12 is a water-soluble micronutrient found in animal foods. Its deficiency is not uncommon in India owing to vegetarianism but often unrecognized due to diverse clinical manifestations, involving hematologic and behavioral and neurologic deterioration. The present review is to collate the current data on vitamin B12status among healthy Indian population. A total of 620 studies were identified using PubMed, out of which 40 studies that matched the selection criteria, were shortlisted and reviewed. The results highlight inadequate vitamin B12 status in most age groups, with the prevalence of deficiency reaching 100%, 78.5%, 61.7% and 75.4% in infants, children and adolescents, adults, elderly and pregnant women, respectively based on varying cut offs. However, due to variation in the biomarkers and cutoffs used for defining clinical and sub-clinical vitamin B12 deficiency and varied laboratory techniques used for analysis, direct comparison of the prevalence of deficiency in the studied population is difficult. Nevertheless, this review highlights that vitamin B12 deficiency is an emerging public health concern that requires further research involving dietary intake of vitamin B12 and serum levels in population groups in India to understand many aspects of vitamin B12 absorption, bioavailability and metabolism.

Keywords


Adult, Deficiency, Healthy, Indian, Infants, Prevalence, Pregnant, Vitamin B12.

References





DOI: https://doi.org/10.21048/ijnd.2019.56.2.23083