Associations of Circulating Methylmalonic Acid and Vitamin B-12 Biomarkers Are Modified by Vegan Dietary Pattern in Adult and Elderly Participants of the Adventist Health Study 2 Calibration Study
Open Access
- 22 January 2020
- journal article
- research article
- Published by Elsevier BV in Current Developments in Nutrition
- Vol. 4 (2), nzaa008
- https://doi.org/10.1093/cdn/nzaa008
Abstract
Elevated plasma methylmalonic acid (MMA) is a functional biomarker of vitamin B-12 status but limited information is available on its prevalence in US vegetarians. The study examines the prevalence of plasma MMA ≥0.27 µmol/L in those consuming vegetarian diets, its associations with vitamin B-12 intake and biomarkers, and the modifying effect of vegetarian patterns on these associations. In this cross-sectional study (n = 785), concentrations of MMA, vitamin B-12, holotranscobalamin (holoTC), and homocysteine (Hcy) were determined in participants of the calibration substudy of the Adventist Health Study 2 (AHS-2). Vitamin B-12 intake from food, fortified food, and supplements was assessed by six 24-h recalls. Regression models were used to estimate ORs of having high MMA as related to vitamin B-12 status biomarkers, vitamin B-12 intake, and dietary pattern. The prevalence of low vitamin B-12 status defined by serum vitamin B-12 <148 pmol/L, holoTC <35 pmol/L, MMA ≥0.27 and ≥0.37 μmol/L, or Hcy ≥15 μmol/L, and the OR of having high MMA did not differ by dietary pattern, possibly due to intake from fortified food and supplements. Total daily vitamin B-12 intake in the second tertile range of 4.4–14.5 μg/d reduced the likelihood of elevated MMA by 69%; and a doubling of vitamin B-12 intake was associated with a 4.3% decrease in plasma MMA. The association between log plasma MMA and biomarkers was modified by diet, with the vegan pattern showing an ∼3-fold stronger association with log serum vitamin B-12 and Hcy than did the nonvegetarian pattern. The prevalence of vitamin B-12 intake <2.0 μg/d was 15.2% in vegans, 10.6% in lacto-ovo-vegetarians, and 6.5% in nonvegetarians. Given the irreversible neurological consequences of vitamin B-12 inadequacy, the importance of regular supplemental vitamin B-12 intake in adult and elderly individuals is stressed.Keywords
Funding Information
- National Cancer Institute (U01CA152939, 2010-38938-20924)
- NIH (U01CA152939, 2010-38938-20924)
This publication has 54 references indexed in Scilit:
- Association of Biochemical B12 Deficiency With Metformin Therapy and Vitamin B12 SupplementsDiabetes Care, 2012
- Population prevalence, attributable risk, and attributable risk percentage for high methylmalonic acid concentrations in the post-folic acid fortification period in the USNutrition & Metabolism, 2012
- Monitoring of vitamin B-12 nutritional status in the United States by using plasma methylmalonic acid and serum vitamin B-12The American Journal of Clinical Nutrition, 2011
- Biomarkers of vitamin B-12 status in NHANES: a roundtable summaryThe American Journal of Clinical Nutrition, 2011
- Serum concentrations of vitamin B12 and folate in British male omnivores, vegetarians and vegans: results from a cross-sectional analysis of the EPIC-Oxford cohort studyEuropean Journal of Clinical Nutrition, 2010
- A community-based model of care improves blood pressure control and delays progression of proteinuria, left ventricular hypertrophy and diastolic dysfunction in Maori and Pacific patients with type 2 diabetes and chronic kidney disease: a randomized controlled trialNephrology Dialysis Transplantation, 2010
- Daily intake of 4 to 7 μg dietary vitamin B-12 is associated with steady concentrations of vitamin B-12–related biomarkers in a healthy young populationThe American Journal of Clinical Nutrition, 2010
- Metabolic evidence of vitamin B-12 deficiency, including high homocysteine and methylmalonic acid and low holotranscobalamin, is more pronounced in older adults with elevated plasma folateThe American Journal of Clinical Nutrition, 2009
- Vegetarian diets: what do we know of their effects on common chronic diseases?The American Journal of Clinical Nutrition, 2009
- In vitamin B 12 deficiency, higher serum folate is associated with increased total homocysteine and methylmalonic acid concentrationsProceedings of the National Academy of Sciences of the United States of America, 2007