Serum vitamin B12 status and multi-vitamin use: An association and the relation to the prevalence of macrocytosis, anemia, and cognitive impairment in the REGARDS cohort Público

Abstract

PURPOSE: Recent studies have provided mixed results in describing the association
between cognitive impairment and high serum folate among those with vitamin B12
deficiency. Data has also shown that those in the highest quintile of serum folate levels
are those who are taking a multi-vitamin. Since multi-vitamins typically contain 6-25 μg
of vitamin B12, these patients are likely those who suffer from an underlying vitamin
B12 absorption problem. The objective of this analysis is to examine the association
between serum vitamin B12 status and multi-vitamin use. Additionally, this analysis will
determine whether there is an increased prevalence of macrocytosis, anemia, and
cognitive impairment among multi-vitamin users with low serum B12 concentrations.
METHODS: The REasons for Geographic and Racial Differences in Stroke cohort is a
national sample of approximately 30,000 African-American and white participants. We
sampled 2,531 REAGRDS participants who were ≥ 50 years with baseline mean
corpuscular volume and hemoglobin measurements, complete medical inventory, and a
six-item screener score to measure serum vitamin B12 concentration. The sample
included 1,000 multi-vitamin users, as defined with the medical inventory. Serum
vitamin B12 status was defined as deficient (≤148 pmol/L), borderline deficient (148 -
221 pmol/L), or normal (>221 pmol/L).
RESULTS: Overall, 2.1% of the sample was deficient and 6.3% was borderline
deficient. Among multi-vitamin users, the prevalence of deficiency was lower than the
prevalence among non-users (1.3% vs. 3.2%). After controlling for age, race, and
gender, multi-vitamin was associated with a ~70% reduction in deficiency [OR: 0.28
(95% CI: 0.20, 0.39)]. Multi-vitamin use or B12 status was not associated with anemia,
or cognitive impairment. There was no significant association between B12 status and
macrocytosis; however, multi-vitamin use was significantly associated with macrocytosis
[OR: 1.25 (95% CI: 1.01, 154)].
CONCLUSIONS: Use of multi-vitamin supplements reduces B12 deficiency and B12
borderline serum levels by two-thirds. However, multi-vitamin use and vitamin B12
status does not consistently predict anemia, macrocytosis or cognitive impairment.
Further research including serum folate levels and presence of intrinsic factor antibodies
is merited to elucidate the inconsistent associations between serum vitamin B12 and
macrocytosis, anemia, or cognitive impairment when stratified by multi-vitamin use.

Table of Contents

BACKGROUND................................................................................................................ 1 INTRODUCTION.............................................................................................................. 6 METHODS..................................................................................................................... 8 RESULTS...................................................................................................................... 11 DISCUSSION................................................................................................................. 14 CONCLUSION................................................................................................................ 20 PUBLIC HEALTH IMPLICATIONS......................................................................................... 21 REFERENCES................................................................................................................. 23 TABLES........................................................................................................................ 28 APPENDIX. IRB Letter of Exemption ................................................................................... 33

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health Health Sciences, Epidemiology
Palabra Clave	Vitamin B12 Macrocytosis Cognitive Impairment REGARDS Multi-vitamin Anemia
Committee Chair / Thesis Advisor	Oakley Jr., Godfrey, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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