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 Public
Williamson, Rebecca Sue (2011)
Published
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
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