The risk of vitamin B12 deficiency

The risk of vitamin B12 deficiency

What is Vitamin B12?

Vitamin B12 is an essential nutrient which can only be absorbed from the diet. The main sources of Vitamin B12 include meat, eggs, shellfish and dairy products. This vitamin is vital for various cellular functions, such as in the production of DNA, blood cells and nerves. For vitamin B12 to be absorbed by the body, it must bind to intrinsic factor, a protein secreted by cells in the stomach. If this does not happen, it can lead to a deficiency in B12.

What are the symptoms of Vitamin B12 deficiency and who’s at risk of deficiency?

A vitamin B12 deficiency manifests itself with symptoms such as fatigue, macrocytic anemia or neurological impairment. Causes of B12 deficiency include malabsorption, chronic alcohol abuse, a vitamin B12-reduced diet (vegetarian, vegan), increased need (pregnancy) and in people aged over 60 years old.

What are the risks of B12 deficiency and how is it detected?

If not detected and treated early enough, B12 deficiency can result in irreversible neurological damage. Therefore, early and accurate diagnosis of Vitamin B12 deficiency is important for public health, as it can prevent and correct the adverse consequences of vitamin B12 deficiency.

Up until recently, “total” Vitamin B12 has been the key marker in assessing B12 deficiency, however, emerging evidence indicates that holoTC (also called “active” B12) is a better marker of early B12 deficiency than total B12 and may be the earliest marker for vitamin B12 depletion, as well as showing a good diagnostic accuracy, sensitivity and specificity. Therefore, “active” Vitamin B12 testing, instead of or in addition to “total” Vitamin B12, has gained importance during the last few years. In more literature, active B12 testing is suggested for future first line assessment of vitamin B12 depletion.

How can Roche tests help to assess Vitamin B12 deficiency?

Roche can now offer the Elecsys® Active B12 (holoTC) on all cobas e immuno-analyzers, completing the anemia portfolio based on trusted ECL technology.

The new holoTC test can help to identify low Vitamin B12 status, before total serum B12 levels drop. This is especially advantageous in higher risk groups, such as women taking oral contraceptives and in people over 65 years old. The Elecsys® Active B12 assay demonstrates proven and trusted ECL quality, physicians can be confident of the results they are acting on to give the patients the right treatment.

References
1) de Benoist; Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food Nutr Bull 2008;29:S238-44.
2) Nielsen et al (2012) Nature Reviews / Gastroenterology & Hepatol.ogy 1;9(6):345-54;
3) Hunt et al.; Vitamin B12 deficiency. BMJ 2014;349:g5226;
4) http://accessmedicine.mhmedical.com/content.aspx?bookid=331&sectionid=40726843, Chapter 105. Megaloblastic anemias;
5) Nielsen et al (2012) Nature Reviews / Gastroenterology & Hepatol.ogy 1;9(6):345-54
6) Green; Indicators for assessing folate and vitamin B-12 status and for monitoring the efficacy of intervention strategies. Am J Clin Nutr. 2011 Aug;94(2):666S-72S.
7) Devalia V, Hamilton MS, Molloy AM, et al. (2014). Guidelines for the diagnosis and treatment of cobalamin and folate disorders. British Journal of Haematology. 2014;166:496-513.
8) Clinical Knowledge Summary (CKS) published in 2013 by the National Institute for Health and Care Excellence (NICE): Anaemia - B12 and folate deficiency. Last revised in July 2015.
https://cks.nice.org.uk/anaemia-b12-and-folate-deficiency
9) Agency for Healthcare Research and Quality (AHRQ), Canada. National Guideline Clearinghouse (NGC):009460. Guideline Summary of ‘Cobalamin (vitamin B12) deficiency - investigation and management. Victoria (BC): British Columbia Medical Services Commission. Published: 1 Jan 2012. https://www.guideline.gov/summaries/summary/38881
10) Langan RC & Zawistoski KJ (2011). American Academy of Family Physicians (AAFP) Guidelines. Update on Vitamin B12 Deficiency. American Family Physician. 2011;83:1425-1430.
11) Australian Government. Department of Health. Medicare Benefits Schedule (MBS) Review - Vitamin B12 Testing Report. Published: February 2014
http://www.health.gov.au/internet/main/publishing.nsf/Content
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12) National Institute for Health and Care Excellence (NICE) Medtech innovation briefing. Active B12 assay for diagnosing vitamin B12 deficiency. Published: 30 September 2015.
https://www.nice.org.uk/advice/mib40