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Vitamin B12 deficiency in a large cohort of healthcare professionals across the network of an eyecare organization in India

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Purpose: To evaluate Vitamin B12 levels in healthcare professionals at a tertiary eyecare centre in India. Methods: This was a cross-sectional study conducted among healthcare professionals working at a tertiary eyecare centre in India. The sample included 2,374 employees. Chemiluminescent immunoassay method (reference range, 211-911 pg/ml) was used to assess serum vitamin B12 levels. Effect of age and gender was analyzed in vitamin B12 normal and vitamin B12 deficient groups. To evaluate risk factors, questions related to vitamin B12 deficiency were asked to the study participants in a survey. Results: The mean age of employees was 29.2 ± 0.7 years. Around 26% of them were vitamin B12 deficient. The proportion of males in the vitamin B12 deficient group (61.2%) was significantly higher (P < 0.0001) than that of the vitamin B12 normal group (44.9%). There was no effect of age on vitamin B12 levels in both vitamin B12 normal and vitamin B12 deficient groups. Mean vitamin B12 levels in males (289.1 ± 22.2 pg/ml) was significantly lower (P < 0.0001) than that of females (338.7 ± 30.0 pg/ml). Conclusion: This is the first such study on eyecare professionals. One-fourth of the eyecare professionals were vitamin B12 deficient. The proportion of males was higher in the vitamin B12 deficiency group. Males had lower vitamin B12 levels than females. Annual blood tests for vitamin B12 are recommended for timely diagnosis and management of vitamin B12 deficiency, particularly in males.
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© 2022 Indian Journal of Ophthalmology | Published by Wolters Kluwer - Medknow
Special Focus, Healthcare Professionals, Original Article
Vitamin B12 deciency in a large cohort of healthcare professionals across the
network of an eyecare organization in India
Sushma Nandyala*, Ashik Mohamed*, Archana Bhargava1, Sunita Chaurasia2, Sirisha Senthil3,
Pravin K Vaddavalli2
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Website:
www.ijo.in
DOI:
10.4103/ijo.IJO_2823_21
PMID:
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Purpose:    
Methods:            
      
               
               
               
Results:
     P


P Conclusion:

 


Key words:
1


    
to this work.
    
     
   

 
 




     
 

avoiding depression. The normal range of serum vitamin


µ

 

 


using metformin.     


past.


[5]  






 


sedentary women.
  
 


Methods

 
Cite this article as: Nandyala S, Mohamed A, Bhargava A, Chaurasia S,
Senthil S, Vaddavalli PK. Vitamin B12 deciency in a large cohort of healthcare
professionals across the network of an eyecare organization in India. Indian
J Ophthalmol 2022;70:1718-21.
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 
Nandyala, et al.: Vitamin B12 deciency in eye care professionals
   



     

   

  
  

   
       












     
   




   




  
 P 

Results





P

P
n
n
 shows the results of survey responses that were






     
     


P
 



P
     
   

 
 

P
Discussion
 
    
    


 
  

  

    


Singla et al.[11]


Table1: Vitamin B12 in eyecare professionals. This table
summarizes age, gender, and vitamin B12 in employees
of a tertiary eyecare center with vitamin B12 deficient and
vitamin B12 normal levels
Parameter Vitamin B12
deficient
Vitamin B12
normal
Age(years), mean±SE 30.6±0.4 29.2±0.7
Male:Female(% males) 371:235(61.2%) 793:975(44.9%)
Vitamin B12 in all(pg/ml)
N(%)
Mean±SE
Minimum
Maximum
606(25.5%)
182.2±2.3
99
210
1768(74.5%)
340.8±18.9
211.1
2000
Vitamin B12 in males(pg/ml)
N(%)
Mean±SE
Minimum
Maximum
371(31.9%)
181.1±2.4
99
210
793(68.1%)
316.7±17.7
211.1
2000
Vitamin B12 in females(pg/
ml)
N(%)
Mean±SE
Minimum
Maximum
235(19.4%)
183.9±2.5
119
210
975(80.6%)
363.3±17.6
211.1
2000
(SE: standard error)
  



with a maximum population following a vegetarian diet.

  
 
     
professionals is very important for maintaining the health of





  
    

   
  
 


   

  This



[15]  


    
     In our
    
     
 
n     

    
higher (P  





levels.
    
   
in males.

     
Green et al.
Table2: Risk factor analysis of vitamin B12 in eyecare professionals. This table summarizes the responses to survey by
employees of a tertiary eye care centre
Question related to B12 deficiency All employees
(208 respondents)
Vitamin B12
deficient (n=81)
Vitamin B12
normal (n=127)
P
Strict vegan 41(19.7%) 18(22.2%) 23(18.1%) 0.43
Predominantly or strictly vegan 107(51.4%) 41(50.6%) 66(52.0%) 0.85
Family history* 15/110(13.6%) 8/45(17.8%) 7/65(10.8%) 0.29
Stomach or intestine diseases or infections 12(5.8%) 5(6.2%) 7(5.5%) 0.53
Immune disorders, human immunodeficiency
virus infection or chronic pancreatitis
15(7.2%) 4(4.9%) 11(8.7%) 0.31
Diabetes mellitus 6(2.9%) 1(1.2%) 5(3.9%) 0.26
Pregnancy and lactation** 2/92(2.2%) 1/35(2.9%) 1/57(1.8%) 0.73
Intake of medications 10(4.8%) 3(3.7%) 7(5.5%) 0.55
(*Available only from 110 respondents; **Applicable only on 92 respondents)
Table3: Regression analysis for vitamin B12 deficiency. This table summarizes the results of analysis of risk factors for
vitamin B12 deficiency by multilevel mixed effects regression analysis
Risk factor PCo‑efficient±standard error 95% confidence intervals
Age 0.56 ‑0.0005±0.0009 ‑0.0023 to 0.0013
Male gender <0.0001 0.10±0.02 0.07 to 0.13
Strict vegan 0.42 0.07±0.08 ‑0.10 to 0.23
Predominantly or strictly vegan 0.89 ‑0.10±0.07 ‑0.14 to 0.12
Family history 0.26 0.15±0.13 ‑0.11 to 0.41
Stomach or intestine diseases or infections 0.49 0.10±0.14 ‑0.18 to 0.38
Immune disorders, human immunodeficiency
virus infection or chronic pancreatitis
0.25 ‑0.15±0.13 ‑0.40 to 0.10
Diabetes mellitus 0.26 ‑0.22±0.20 ‑0.61 to 0.17
Pregnancy and lactation 0.73 0.12±0.35 ‑0.56 to 0.80
Intake of medications 0.41 ‑0.13±0.16 ‑0.43 to 0.18
 
Nandyala, et al.: Vitamin B12 deciency in eye care professionals
    
      

   


in old ages.

 




et al.







 

  






Conclusion


 
   

   



  
  

Financial support and sponsorship
 

Conicts of interest

References
  
   

 
   

 

   

    
    

 

 

  
  

 
  


    
et al
   

 

 


 
et al

     
et al 

   
 

 

 
et al

 


       
 
  

  
et al. Vitamin B    

   
et al


     
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  

... This shortage can lead to damage to the blood and nerve systems, hinder cognitive development in infants and children, and heighten fertility risks in pregnant women [3]. The instability of hydroxycobalamin, mecobalamin, and adenosylcobalamin in cobalamin necessitates the use of synthetic cyanocobalamin in milk powder [4,5]. Cyanocobalamin, a compound with a molecular weight of 1355.4, ...
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This study presents a new technique for determining vitamin B12 in milk powder using high-performance liquid chromatography-inductively coupled plasma mass spectrometry (HPLC-ICP-MS). We used ultrasonics with potassium ferrocyanide and zinc acetate solutions to extract the samples. 59Co was employed as the analytical target for cyanocobalamin. It was separated using a Phenomenex Luna 5 μm C18 (250 × 4.6 mm) chromatographic column with a mobile phase consisting of 1.6 mmol/L EDTA and 0.4 mmol/L KH2PO4 in a 60% v/v methanol solution (pH = 4.0). The sample has an excellent separating degree for free cobalt and cyanocobalamin, and isocratic elution can be finished within 4.0 min. To eliminate the matrix interference due to the presence of milk powder, we applied collision mode (KED). The linear range of cyanocobalamine ranged from 1.0 μg/L to 20 μg/L, with correlation coefficients (r2) of 0.9994. The limit of detection (LOD) was 0.63 μg/kg, and the limit of quantitation (LOQ) was 2.11 μg/kg. The mean recoveries were in the range of 87.4–103.6%. The accuracy and precision of the developed method are well suited for the fast quantification of the trace vitamin B12 in milk powder.
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Objective To find out the frequency of hyperhomocysteinemia in young ischaemic stroke patients and its relationship with early morbidity and mortality. Methods This prospective study was conducted on young ischemic stroke patients in Pakistan Atomic Energy Commission General Hospital, Islamabad. Ischaemic stroke patients of age < 45 years were selected from both the outpatient and inpatient departments. A fasting venous blood sample was sent for analysis. Data was collected through a structured proforma and were analyzed using SPSS 24.0 (IBM Corp, Armonk, NY, US). The outcome was measured at discharge using the modified Rankin scale. Results The mean age of the 71 patients in the study was 35.8 years. Overall, 36 (50.7%) cases had hyper-homocysteinemia. The frequency was significantly higher in males and in the age group 36-45 years (63.4%). Levels of homocysteine did not significantly affect the outcome at discharge. Conclusion Hyperhomocysteinaemia, a modifiable risk factor for ischaemic stroke, was seen in about half of young stroke patients. The levels of homocysteine did not correlate with early stroke outcome.
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Background: Vitamin B12 deficiency is believed to be widespread in Indian population. However, more data is needed to fuel a meaningful debate on preventive and therapeutic strategies. Aims and objectives: Objective of the current study is to evaluate status of vitamin B12 levels in people from a tier 3 city and among people living in an urban area with or without diabetes. Settings and design: Retrospective, cross-sectional study. Methodology: Data captured in electronic medical records (EMR) of an endocrine practice and from a diagnostic laboratory was analysed. Statistical analysis used: Statistical analysis was done using open source software "Jamovi". Results: Prevalence of vitamin B12 deficiency (Vitamin B12 levels <200 pg/ml) in tier 3 city was 47.19% (n = 267). From an urban endocrine practice, database of 11913 patients was searched for reports of vitamin B12 levels. Prevalence of vitamin B12 deficiency was 37.76% in people with pre-diabetes (n = 92), 31.23% in people with endocrine problems other than diabetes and pre-diabetes (n = 285) and 18.25% in people with diabetes (n = 378). Tier 3 city population had significantly lower vitamin B12 levels than people living in an urban area and attending an endocrine clinic. Vitamin B12 levels were significantly higher in people with diabetes as compared to people with other endocrine problems. Conclusion: Prevalence of vitamin B12 deficiency is 47% in north Indian population. People with diabetes have higher vitamin B12 levels than general population though still have high prevalence of deficiency. This data shows that Vitamin B12 deficiency is widespread in Indian population.
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Background: Vitamin B12 deficiency is associated with hematological, neurological, and cardiovascular consequences. Epidemiologic data on these related illnesses indicate gender differences. Methods: A cross-sectional study was designed to examine gender differences in vitamin B12 deficiency among a healthy population. Data from healthy individuals aged 18-65, who were provided with a routine medical evaluation during 2000-2014, were retrieved from the medical charts. Individuals with background illnesses and those who had used medications or nutritional supplements were excluded. Vitamin B12 deficiency was defined by 2 cutoff values (206 and 140 pmol/L). The multivariate analysis was adjusted for age, body mass index, estimated glomerular filtration rate, hyperhomocysteinemia, folate deficiency, albumin, and transferrin saturation. Sensitivity analyses were implemented by excluding individuals with anemia, hyperhomocysteinemia, or folate deficiency and by age stratification. Results: In all, 7,963 individuals met the inclusion criteria. Serum vitamin B12 mean levels were 312.36 and 284.31 pmol/L for women and men respectively (p < 0.001). Deficiency prevalence was greater for men (25.5%) in comparison with women (18.9%; p < 0.001). Men were strongly associated with severe deficiency (adjusted OR 2.26; 95% CI 1.43-3.56). Conclusions: Among the healthy population, men are susceptible to vitamin B12 deficiency. This can be explained by neither diet habits nor estrogen effects. Genetic variations are therefore hypothesized to play a role.
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Vitamin B12 (B12; also known as cobalamin) is a B vitamin that has an important role in cellular metabolism, especially in DNA synthesis, methylation and mitochondrial metabolism. Clinical B12 deficiency with classic haematological and neurological manifestations is relatively uncommon. However, subclinical deficiency affects between 2.5% and 26% of the general population depending on the definition used, although the clinical relevance is unclear. B12 deficiency can affect individuals at all ages, but most particularly elderly individuals. Infants, children, adolescents and women of reproductive age are also at high risk of deficiency in populations where dietary intake of B12‑containing animal-derived foods is restricted. Deficiency is caused by either inadequate intake, inadequate bioavailability or malabsorption. Disruption of B12 transport in the blood, or impaired cellular uptake or metabolism causes an intracellular deficiency. Diagnostic biomarkers for B12 status include decreased levels of circulating total B12 and transcobalamin-bound B12, and abnormally increased levels of homocysteine and methylmalonic acid. However, the exact cut-offs to classify clinical and subclinical deficiency remain debated. Management depends on B12 supplementation, either via high-dose oral routes or via parenteral administration. This Primer describes the current knowledge surrounding B12 deficiency, and highlights improvements in diagnostic methods as well as shifting concepts about the prevalence, causes and manifestations of B12 deficiency.
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Background: Female athletes and active women require adequate nutrition for optimal health and performance. Nutrition assessments are needed to identify potential nutrients of concern. Folate, vitamin B6, and vitamin B12 function in important pathways used during physical activity and female athletes may be at risk for poor status of these micronutrients. This cross-sectional study described a comprehensive nutrition assessment of the B-vitamins (folate, vitamin B6, and vitamin B12) using both dietary (food and dietary supplements) and biochemical assessments among highly active and sedentary women. Methods: Highly active (n = 29; age 20 ± 2 years; body mass index (BMI) 23.8 ± 3.5 kg/m²) and sedentary (n = 29; age 24 ± 3 years; BMI 22.6 ± 3.0 kg/m²) women were recruited for this study. Participants completed 7-day weighed food records and a fasting blood draw. Results: Although the highly active women reported higher intakes of energy (p < 0.01), folate (p < 0.01), vitamin B6 (p < 0.01), and vitamin B12 (p < 0.01), no significant differences were found between the groups for biomarkers of folate, vitamin B6, and vitamin B12. All of the highly active women had biomarkers within the desired reference ranges, suggesting good status. In general, most participants were able to meet the 1998 Recommended Daily Allowance (RDA) from food alone. For the women that reported using dietary supplements, micronutrient intakes met the 1998 RDA and in some cases, exceeded the Tolerable Upper Intake Level. Conclusion: This nutrition assessment documented good status for folate, vitamin B6, and vitamin B12 in the highly active women. Similar assessment approaches (food, dietary supplements, and biomarkers) should to completed with other nutrients of concern for the female athlete.
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Driven by economic development and urbanisation, animal-based protein (ABP) consumption has surged worldwide over the last 50years, rising from 61g per person per day in 1961 to 80g per person per day in 2011. This contribution analyses the apparent convergence of dietary models worldwide with respect to the proportion of ABP and especially meat in intake. By using FAO data for 183 countries over the period 1961-2011, the authors show the connection between annual per capita GDP and the level of ABP (R2=0.62) and meat consumption (R2=0.62). They emphasise the surge in ABP intake in emerging countries (China, Brazil) which has partly replaced plant protein. However, for similar degrees of economic development, the composition of ABPs and the position of meat within this category vary significantly among countries, suggesting that historical, geographical, cultural and religious factors may be involved. Copyright © 2015. Published by Elsevier Ltd.
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Objective Randomized controlled trials and observational studies have yielded inconsistent results on the effects of metformin on vitamin B12 reduction. We therefore performed a systematic review to analyze the effects of metformin on vitamin B12 concentration. Methods PubMed, Medline, Embase, and the Cochrane central registry of controlled trials were searched to identify randomized controlled trials and observational studies exploring the association between metformin and vitamin B12 concentration in patients with type 2 diabetes mellitus or polycystic ovary syndrome. The main outcome measure was changes in serum vitamin B12 concentration after 6–208 weeks of treatment with metformin, as compared with placebo or other anti-hyperglycemic therapy. Results Six randomized controlled trials met the inclusion criteria. Serum vitamin B12 concentrations were significantly lower in patients treated with metformin than in those who received placebo or rosiglitazone (mean difference [MD], −53.93 pmol/L; 95% confidence interval [CI], −81.44 to −26.42 pmol/L, P = 0.0001). Subgroup analysis identified four trials in which patients received a lower dose of metformin (<2000 mg/d) and two in which they received a higher dose (≥2000 mg/d), with MDs in vitamin B12 concentration after metformin treatment of −37.99 pmol/L (95% CI, −57.44 to −18.54 pmol/L, P = 0.0001) and −78.62 pmol/L (95% CI, −106.37 to −50.86 pmol/L, P<0.00001), respectively. Conclusions The reduction of vitamin B12 may be induced by metformin in a dose dependent manner.