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Introduction: Pregnancy and lactation represent a complex stage from a nutritional point of view, since energy, protein and micronutrient requirements increase during these stages. The literature describes that a well-planned plant-based diet can be sufficient in energy, macronutrients and micronutrients, with the exception of vitamin B12 and possibly n3 polyunsaturated fatty acids, mainly EPA and DHA. During the last few years, adherence to this diet has increased rapidly in the population, so the main objective of this article is to review the current evidence on the intake and concentrations of vitamin B12, EPA and DHA during pregnancy and lactation in women following a plant-based diet. A literature search was performed in PubMed, Scopus, Web of Science and Ovid MedLine using free terms and MESH. Eleven articles were selected in this review. Well-planned vegetarian and vegan diets, with adequate supplementation of vitamin B12, EPA and DHA, are compatible during pregnancy and lactation, being a positive predictor of their content in breast milk. A similar situation was observed in plasma levels in women supplemented with B12. However, it is important to continue with research in this area that considers an adequate dietary anamnesis, integral evaluation of nutritional status, estimation of nutritional requirements and an individualized nutritional plan.

Background: Retinal vein occlusion (RVO) is mainly related with vascular risk factors (VRF)., Objectives: To analyze the lipid profile and serum folate, vitamin B 12 and homocysteine levels, in patients with RVO and a population-based control group., Patients and Methods: Case-control study. Patients with RVO were assessed during an 11-year period., Results: We included 368 patients and 325 controls of similar age and sex. HDL cholesterol and folate levels were lower (52 [43-63] mg/dL vs. 55 [46-66]; p = 0.016 and 7 [5-10] ng/mL vs. 9 [7-13]; p < 0.0001, respectively) and non-HDL cholesterol and homocysteine levels higher (148.9 ± 37.3 mg/dL vs. 142.9 ± 34.5; p = 0.03 and 13.4 [11.2-18.2] μmol/L vs. 11.1 [9.0-14.4]; p < 0.001) in patients with RVO than controls. Although total cholesterol, LDL-C, and triglyceride levels were higher and serum vitamin B 12 levels were lower in RVO patients, these differences did not reach statistical significance., Conclusions: RVO-patients have lower serum HDL-C and folate levels and higher non-HDL-C and serum homocysteine levels than population-based controls of similar age and sex. In patients with RVO, apart from the lipid profile, determination of serum homocysteine, folate and vitamin B 12 levels might be useful, as well as the treatment of their alterations., (Copyright © 2020 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: In infants, vitamin B12 deficiency is mainly due to nutritional deficiencies related to maternal deficit. Most cases of maternal deficiencies are associated with vegetarian diets. Pernicious anemia is an au toimmune disease that affects the absorption of this vitamin. Although it is less common than nutri tional deficiency, is also an important cause of maternal deficiency., Objective: to report a case of an infant with vitB12 deficiency, secondary to pernicious anemia in his mother, and to review the most important aspects of this disease in childhood., Clinical Case: Nine months-old male infant, without pathological perinatal history, exclusively breastfed, with persistent rejection of solid food from 6 months of age. One month before hospitalization, he progressively presented hyporesponsiveness, with fluctuating state of alertness, regression of motor development milestones, and vomiting. The blood count showed macrocytic anemia and neutropenia. Vitamin B12 deficiency was confirmed in the patient. He received treatment with intramuscular vitamin B12 with good clinical and laboratory response. Maternal B12 deficiency was confirmed as the cause of the infant's deficiency. Since the mother reported no dietary restrictions, anti-intrinsic factor and anti-parietal cell antibodies were measured, leading to the diagnosis of pernicious anemia., Conclusions: Early recognition is essential to prevent the development of potentially irreversible neurological damage. Maternal pernicious ane mia should be considered in children with megaloblastic anemia, especially in those whose mothers do not follow vegetarian diets.

Low back pain, as well as other musculoskeletal disorders (neck pain, osteoarthritis, etc.), are a very frequent cause of consultation both in primary care and in other hospital specialties and are usually associated with high functional and work disability. Acute low back pain can present different nociceptive, neuropathic and nonciplastic components, which leads to consider it as a mixed type pain. The importance of the concept of mixed pain is due to the fact that the symptomatic relief of these pathologies requires a multimodal therapeutic approach to various pharmacological targets. The antinociceptive role of the B vitamin complex has been recognized for several decades, specifically the combination of Thiamine, Pyridoxine and Cyanocobalamin (TPC). Likewise, there is accumulated evidence that indicates an adjuvant analgesic action in low back pain. The aim of the present review is to present the existing evidence and the latest findings on the therapeutic effects of the TPC combination in low back pain. Likewise, some of the most relevant mechanisms of action involved that can explain these effects are analyzed. The reviewed evidence indicates that the combined use of PCT has an adjuvant analgesic effect in mixed pain, specifically in low back pain and other musculoskeletal disorders with nociceptive and neuropathic components. This effect can be explained by an anti-inflammatory, antinociceptive, neuroprotective and neuromodulatory action of the TPC combination on the descending pain system., (Copyright © 2021 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Vitamin B 12 levels are usually measured in Primary Care when the patients have symptoms or risk factors associated with its deficiency, mostly in the elderly. However, no evidence has been found to support the recommendation of screening in the general population. The aim of this study is to assess the relevance of having extended the screening of vitamin B 12 deficiency to a younger population, after observing an increase in the prescription of this injected vitamin in a population under 65 years, by analysing the vitamin B 12 values obtained., Material and Method: A descriptive, retrospective, observational study was conducted on a sample consisting of 5,531 patients from Barajas Health Primary Centre, Madrid, between 2008 and 2012, and on whom a blood test was performed for any reason, with values of vitamin B 12 ., Results: A deficiency was found in 9.1% (SD 2.3) of the patients, of whom 49.4% were less than 65 years. The deficiencies were associated (P<.001, 95% CI) with age, dementia, changes in blood red cell counts, memory, and with the taking of metformin and proton pump inhibitors (P=.007)., Conclusion: The prevalence of vitamin B 12 deficiency in our served population is similar in patients older and younger than 65 years. The extended screening was relevant., (Copyright © 2017 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España, S.L.U. All rights reserved.)

The "fragility" of the nervous system, especially concerning to its nutrition and metabolism, explains why vitamin deficits are an important cause of neurological pathology. Some deficiency diseases, which can be very severe and irreversible, are still present in our environment; diagnosis, which must be early so as not to delay treatment, can be difficult if we do not have them in mind. In this review we address the most relevant neurological diseases associated with thiamine, folate and cobalamin deficiency, and we focus especially combined subacute degeneration and Wernicke-Korsakoff syndrome.

Vitamin B12 deficiency is one of the main complications of vegetarianism. Infants of vegetarian mothers have greater risk of deficiency and irreversible neurological compromise if deficiency is not identified and treated. We describe the case of a 1 month 20 days-old infant who consulted due to paroxysmal episodes of epileptogenic mechanism; laboratory tests identified a deficiency in vitamin B12 as the cause. After confirmation of diagnosis, treatment with intramuscular vitamin B12 was established with full remission of symptoms, good evolution and psychomotor development without alterations. Considering current alimentary trends, it is necessary to include a detailed maternal nutritional anamnesis in regular clinical practice, in order to detect the risk of this vitamin deficiency at an early stage and to prevent it., Competing Interests: None, (Sociedad Argentina de Pediatría.)

Background: Supplementation of vitamin B12 in older adults is a common practice to avoid vitamin B12 insufficiency. However, there is a paucity of information about the effects of cobalamin excess., Aim: To asses any potential effects of high levels vitamin B12 on mortality on adults aged ≥ 65 years admitted to an internal medicine service., Material and Methods: We Prospectively studied patients admitted to an internal medicine service of an academic hospital from September 2017 to September 2018, who were able to give their consent and answer questionnaires. We tabulated age, gender, medical history, comorbidity index (Charlson), frailty score (Fried scale), admission diagnosis and blood tests performed within 48 hours of admission. The primary outcome was death by any cause in less of 30 days or after one of year follow up, determined according to death certificates., Results: We included 93 patients aged 65 to 94 years (53% males). Fifteen patients died during the year of follow up (five within 30 days of admission). Those who died had higher cobalamin levels than survivors (1080.07 ± 788.09 and 656.68 ± 497.33 pg/mL respectively, p = 0.02). Patients who died had also a significantly lower corrected serum calcium, sodium (p = 0.04) and a medical history of chronic liver disease (p = 0.03). In the multivariable analysis, only vitamin B12 preserved the association with mortality (p = 0.009)., Conclusions: There was a significant association between high levels of cobalamin and all-cause mortality in this group of patients aged ≥ 65 years-old.

Bariatric surgery is a treatment that guarantees a substantial and lasting weight loss in addition to the tangible benefits relating to obesity-associated medical conditions. The increasing number of bariatric surgeries has revealed an increasing number of complications related to this procedure, including Wernicke´s encephalopathy and vitamin B deficiency polyneuropathies. Herein, a 7-week post-surgery case of Wernicke´s encephalopathy is presented that emphasizes the importance of an early recognition of these symptoms so as to initiate intervention during the reversible phase of these potentially lethal pathologies.

Introduction: Increased blood homocysteine levels are a known cardiovascular risk factor. Epileptic patients on long-term treatment with antiepileptic drugs may present higher homocysteine levels and, consequently, a potential increase in cardiovascular risk., Material and Methods: We conducted an observational case-control study to compare plasma levels of homocysteine, folic acid, and vitamin B 12 ., Results: Our study included a total of 88 subjects: 52 patients with epilepsy and 36 controls. Epileptic patients showed higher homocysteine levels (P=.084) and lower levels of folic acid (P<.05)., Conclusion: Homocysteine levels should be monitored in epileptic patients on long-term treatment with antiepileptic drugs. We suggest starting specific treatment in patients with high homocysteine levels., (Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.)

Metabolic, biochemical, and hormonal changes occur in chronic renal failure usually associated with hyponutrition states. In predialysis patients, knowing the nutritional state about water-soluble vitamins such as thiamine, riboflavin, pyridoxine, cianocobalamine, and folic acid is becoming more and more important since some of the manifestations of chronic renal failure may be due to the deficiency of some of these water-soluble vitamins. The metabolic pathways in which most of these vitamins participate are interrelated and it is difficult to understand how the individual deficits of each vitamin affect renal pathology. This work aims at reviewing not only this issue but also the status of these water-soluble vitamins that different authors have found in groups of predialysis patients. On the other hand, the issue on the high prevalence of hyperhomocysteinemia in chronic renal failure as the main mortality risk factor due to cardiovascular pathologies as well as the implication of these vitamins in the metabolism of homocysteine, and consequently in plasma levels of this metabolite in predialysis patients is reviewed.

Introduction: Introduction: the vitamin cobalamin is essential for a proper functioning of the CNS, hematopoiesis, and DNA synthesis. Its deficiency is frequently secondary to pernicious anemia or strict vegetarian diets. Case report: an 18-month-old male infant presented with a decreased level of consciousness and movement disorder (tremor and choreiform movements) of several hours' standing. He had a history of delayed acquisition of motor milestones (not standing, monosyllabic language), and progressive loss of these over the last few weeks (head support and sitting). He had been breastfed from birth. His family has a vegetarian diet. In neuroimages, cranial CT and MRI scans showed generalized supratentorial atrophy involving both matters and the basal ganglia. Treatment was started with intramuscular vitamin B12, which increased its levels. Subsequently, the patient was subjected to dietary diversification and oral cyanocobalamin, with clinical normalization after 6 months and radiological normalization after 7 months. Conclusions: we emphasize the importance of vitamin B12 supplementation during pregnancy and lactation in vegetarina mothers and their infants.

Objective. To estimate the national and regional population attributable fraction (PAF) and potential number of preventable anemia cases for three nutritional risk factors (iron, red blood cell folate [RBCF], and vitamin B12 deficiencies) among women of childbearing age in Belize. Methods. A national probability-based household and micronutrient survey capturing sociodemographic and health information was conducted among 937 nonpregnant Belizean women aged 15–49 years. Blood samples were collected to determine hemoglobin, ferritin, alpha-1-glycoprotein (AGP), RBCF, and vitamin B12 status. All analyses used sample weights and design variables to reflect a complex sample survey. Logistic regression was used to determine adjusted prevalence risk (aPR) ratios, which were then used to estimate national and regional PAF for anemia. Results. The overall prevalence of anemia (hemoglobin

Objective: To describe the current status of micronutrient deficiencies (MD) and anemia in Mexican children., Materials and Methods: Serum data from 1 382 pre-school-age chil-dren (1-4 years) and 3 590 school-age children (5-11 years) Ensanut 2018-19 participants were analyzed. Iron deficiency (ID), vitamin B12 deficiency (B12D), vitamin A depletion (VADp), and anemia were identified. Logistic regression models were used to identify associations between socio-demographic characteristics of children and MD., Results: Anemia was present in 28.9 and 19.2% of the children aged 1-4 and 5-11, respectively; in ID 10 and 5.1%; B12D, in 5.1 and 4.8%, and VADp, in 4.7 and 4.3%. 18.5% of the preschool-age children and 13% of the school-age children had at least one MD associated to anemia., Conclusions: MD and anemia affect the younger children in larger proportion. Fortification and supplementation programs should be reinforced to avoid the long-term consequences of MD.

Durante la insuficiencia renal crónica ocurren cambios metabólicos, bioquímicos y hormonales que suelen ir acompañados frecuentemente de estados de malnutrición. En pacientes en prediálisis, conocer el estado nutricional en vitaminas hidrosolubles como la tiamina, riboflavina, piridoxina, cianocobalamaina y ácido fólico cobra cada vez más importancia ya que algunas de las manifestaciones de la insuficiencia renal crónica podrían deberse a la deficiencia de algunas de estas vitaminas hidrosolubles. Las rutas metabólicas en las que participan la mayoría de ellas se encuentran interrelacionadas y resulta complejo comprender de qué manera afecta individualmente la deficiencia de cada vitamina a la patología renal. Este trabajo trata de revisar no sólo este aspecto, sino también el estatus en estas vitaminas hidrosolubles que diferentes autores han encontrado en grupos de pacientes en prediálisis. Por otra parte se aborda la problemática de la elevada prevalencia de hiperhomocisteinemia en la insuficiencia renal crónica como principal factor de riesgo de mortalidad por patologías cardiovasculares, así como la implicación de las vitaminas objeto de esta revisión en el metabolismo de la homocisteína y por consiguiente en los niveles plasmáticos de dicho metabolito en pacientes en prediálisis.Metabolic, biochemical, and hormonal changes occur in chronic renal failure usually associated with hyponutrition states. In predialysis patients, knowing the nutritional state about water-soluble vitamins such as thiamine, riboflavin, pyridoxine, cianocobalamine, and folic acid is becoming more and more important since some of the manifestations of chronic renal failure may be due to the deficiency of some of these water-soluble vitamins. The metabolic pathways in which most of these vitamins participate are interrelated and it is difficult to understand how the individual deficits of each vitamin affect renal pathology. This work aims at reviewing not only this issue but also the status of these water-soluble vitamins that different authors have found in groups of predialysis patients. On the other hand, the issue on the high prevalence of hyperhomocysteinemia in chronic renal failure as the main mortality risk factor due to cardiovascular pathologies as well as the implication of these vitamins in the metabolism of homocysteine, and consequently in plasma levels of this metabolite in predialysis patients is reviewed.

Background and Objective: We intended to ascertain the effectiveness and safety of oral solutions of magnesium and vitamin B(6) in alleviating the symptoms emerged during clinical exacerbations in children aged 7-14 years suffering from Tourette syndrome (TS). We also aimed to determine the mean and the standard deviation of such an improvement in order to estimate sample sizes in future assays with a control group., Patients and Method: The treatment under investigation was administered to children diagnosed with TS, in accordance with Diagnostic and Statistical Manual of Mental Disorders, fourth edition -IV, under conditions of clinical exacerbation. The effects were scored on the Yale Global Tics Severity Scale (YGTSS) at 0, 15, 30, 60 and 90 days., Results: The total tics score decreased from 26.7 (t0) to 12.9 (t4) and the total effect on the YGTSS was a reduction from 58.1 to 18.8. Both results were statistically significant. With respect to the application of conventional treatment or otherwise, no significant differences were observed. No side effects were seen., Conclusions: The treatment assayed is safe and effective in reducing the harmful effects of TS in children. Further studies are needed, with a control group, and evaluation of different doses of the drugs.

There has been a great interest in the last decades about the clinical significance of elevated total plasma homocysteine (tHcy), and especially its possible association with an increased cardiovascular risk. Measurement of tHcy is clearly indicated when homocystinuria is suspected in young or adult patients (in the presence of a severe, atypical or progressive myopia with ectopia lentis and/or venous thromboembolism and/or severe, premature or atypical atherosclerotic vascular disease) and in the evaluation of vitamin B12 and/or folic acid deficiencies. The current evidence does not support either the screening measurement of tHcy or the treatment with vitamin B12 and/or folic acid supplementation in patients with cardiovascular disease. It is important to remember that it remains to be proved whether the long-term administration of folic acid at pharmacological doses is safe.

Objective: To test vitamin B12 plasma levels in type 2 diabetic patients treated with metformin in our area., Methods: A cross-sectional, observational study of consecutive type 2 diabetic patients on drug treatment attending an internal medicine outpatient clinic., Results: One hundred and nine patients (81 treated with metformin) were enrolled into the study. Mean time on metformin treatment was 43.5 months and mean drug dose was 1,779 mg/day. Patients treated with metformin had significantly lower vitamin B(12) plasma levels (393.5 vs. 509 pg/mL, P = .0008). Seven (8.6%) of 81 patients treated with metformin and none of the 28 patients not treated with the drug had vitamin B(12) plasma levels lower than 197 pg/mL. No correlation was found between vitamin B12 plasma levles and metformin treatment time or dosage., Conclusions: In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B12 plasma levels. Vitamin B12 deficiency associated with metformin is relatively common in our area., (Copyright © 2012 SEEN. Published by Elsevier Espana. All rights reserved.)

Objective: The objective of this study were: a) to investigate vitamin B12 deficiency among and advanced aged, clinically healthy, asymptomatic population, presumably with a high prevalence of vitamin B12 deficiency. This deficiency was defined as an increase in the MMA/creatinine ratio in urine and/or basal plasma HT levels which normalize after the administration of vitamin B12; b) its relationship with plasma vitamin B12 levels., Subjects and Methods: A total of 45 subjects were studied, 19 in the Group of Gastrectomized patients, who were selected on the basis of an age over 60 years and partial gastrectomy of more than five years, and 26 in the Geriatric Group selected in two nursing homes. All of them were asymptopatic and "healthy" according to data in the clinical records and clinical examination, analytical studies, and none of them was taking any drug that might alter results. After basal analytical studies, which included B12, folates, metilmalonic acid/creatinine (MMA/creatinine) in urine and total plasma homocysteine (TH), i.m. vitamin B12 was administered for 15 days to the gastrectomized patients and oral B12 for 28 days with 2.5 mg folic acid for the last 14 days to the patients in the Geriatric Group. Basal analytical studies were repeated at the end of the study., Results: Basal analytical studies were normal with the exception of two subjects with low levels of hemoglobin and 8 with decreased MCV. Only one subject had decreased serum cobalamines. Nine subjects (20%) were identified with increased basal levels of MMA/creatinine which normalized after decreasing between 97% and 12% after the administration of vitamin B12. TH and MCV also decreased significantly. Basal levels of vitamin B12 ranged from 244 pg/ml to 483 pg/ml (n = 220 pg/ml-980 pg/ml)., Conclusions: Vitamin B12 deficiency, defined as an increase in the MMA/creatinine ratio and TH normalized with B12, is highly prevalent among elderly subjects and may occur in absence of clinical and/or analytical manifestations. Given the widespread recommendation of quantitating MMA and TH for the diagnosis of borderline cases of vitamin B12 deficiency, such disturbance may occur in clinically and biochemically normal subjects. Thus, a special caution should be exerted, given the existing comorbidity in advanced ages, before attributing B12 deficiency to a condition which may be the expression of another concomitant condition.

High serum levels of vitamin B12 or cobalamin, also called hypervitaminemia B12, is a frequently underestimated biological abnormality. According to the literature, some of the entities related to this finding are solid neoplasia (primary or metastatic) and acute or chronic hematological diseases. Other causes include liver disorders, monoclonal gammapathy of undetermined significance, renal failure and, less frequently, excess of vitamin B12 intake, inflammatory or autoimmune diseases, and transient hematological disorders (neutrophilia and secondary eosinophilia). This article reports on causes of hypervitaminosis B12, our experience and a review of the literature.

Background: Patients with liver disease frequently experience changes in their nutritional status., Objective: To determine changes in vitamin B12 and folic acid plasma levels in patients with chronic cirrhosis and to assess whether these parameters may be useful in the etiologic diagnosis of this disease., Patients and Methods: Thirty-nine patients admitted for decompensated cirrhosis (29 with alcoholic etiology and 10 with non-alcoholic etiology) and 35 controls were prospectively studied. Plasma levels of vitamin B(12), folate acid, mean corpuscular volume (MCV), aspartate aminotransferase (AST), alanine aminotransferase (ALT), AST/ALT ratio, and gamma-glutamyltransferase (GGT), among other parameters, were measured., Results: Vitamin B(12) levels were 1151+/-568pg/ml in patients with decompensated cirrhosis and 440+/-133pg/ml in controls (p<0.05). Plasma folate levels were 8.57+/-3.8ng/ml in controls and 6.68+/-2.74ng/ml in patients with cirrhosis (p<0.05). Folate levels were lower in patients with alcoholic cirrhosis (mean value, 5.7+/-2.1) than in those with non-alcoholic cirrhosis (9.3+/-2.6; p<0.0005). The vitamin B(12)/folate ratio discriminated alcoholic etiology better than other parameters such as AST, ALT, MCV, AST/ALT ratio and GGT., Conclusions: Plasma levels of vitamin B12 in patients with decompensated chronic liver disease are high, whereas plasma folate levels are low. The ratio between vitamin B12 and folic acid may be useful in the differential diagnosis of the etiology of chronic liver disease., (Copyright 2009 Elsevier España, S.L. All rights reserved.)

Idiopathic endocranial hypertension is infrequently associated with hypovitaminosis A and D. The case of an 8-year-old female with 24-hour blurred vision and bilateral papilledema is presented. Nuclear magnetic resonance was normal. Opening pressure of cerebrospinal fluid: 260 mmH2O. She presented vitamin A and D deficiency and started replacement therapy. The second case corresponds to a 12-year-old male with fever and odynophagia of 3 days. History of glomerulonephritis and overweight. He had bipalpebral edema and papilledema. Computed tomography scan of the orbit: increase of fluid in the sheath of both optic nerves. Nuclear magnetic resonance: intrasellar arachnoidocele. Opening pressure of cerebrospinal fluid: 400 mmH2O. He presented vitamin D and B6 deficiency and started replacement treatment. The elevation of intracranial pressure triggers compensation mechanisms that, when they fail, can compromise life or cause serious neurological disabilities. Recognizing the cause for an accurate therapeutic approach is key to reduce the morbidity and mortality associated with this pathology., (Sociedad Argentina de Pediatría.)

Serum concentration of vitamin B12 is reported in children who had previously lost partially or totally the ileum. Only one of them showed a definite pondostatural retardation when evaluation of growth and development was done. No evidence of anemia was found in any one of them and the estimation of vitamin B12 was abnormally low in only one case. Findings are discussed and the necessity to carry out a periodic control of vitamin B12 in children with ileal resection is stressed.