Adequate vitamin B12 and folate status of Norwegian vegans and vegetarians.

Sigrun Henjum, Synne Groufh-Jacobsen, Allen Lindsay, Ellen Raael, Anna Maria Israelsson et al.

Other The British journal of nutrition 2023 6 citações

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Study Design

Tipo de Estudo: cross_sectional
Tamanho da Amostra: 205

Intervenção: Adequate vitamin B12 and folate status of Norwegian vegans and vegetarians. not applicable (observational; supplement use self-reported)
Comparador: Placebo
Direção do Efeito: Neutral
Risco de Viés: Moderate

Abstract

Plant-based diets may increase the risk of vitamin B12 deficiency due to limited intake of animal-source foods, while dietary folate increases when adhering to plant-based diets. In this cross-sectional study, we evaluated the B12 and folate status of Norwegian vegans and vegetarians using dietary B12 intake, B12 and folic acid supplement use, and biomarkers (serum B12 (B12), plasma total homocysteine (tHcy), plasma methylmalonic acid (MMA) and serum folate). Vegans (n 115) and vegetarians (n 90) completed a 24-h dietary recall and a FFQ and provided a non-fasting blood sample. cB12, a combined indicator for evaluation of B12 status, was calculated. B12 status was adequate in both vegans and vegetarians according to the cB12 indicator; however 4 % had elevated B12. Serum B12, tHcy, MMA concentrations and the cB12 indicator (overall median: 357 pmol/l, 9·0 µmol/l, 0·18 µmol/l, 1·30 (cB12)) did not differ between vegans and vegetarians, unlike for folate (vegans: 25·8 nmol/l, vegetarians: 21·6 nmol/l, P = 0·027). Serum B12 concentration < 221 pmol/l was found in 14 % of all participants. Vegetarians revealed the highest proportion of participants below the recommended daily intake of 2 µg/d including supplements (40 v. 18 %, P < 0·001). Predictors of higher serum B12 concentrations were average daily supplement use and older age. Folate deficiency (< 10 nmol/l) was uncommon overall (< 2·5 %). The combined indicator cB12 suggested that none of the participants was B12-depleted; however, low serum B12 concentration was found in 14 % of the participants. Folate concentrations were adequate, indicating adequate folate intake in Norwegian vegans and vegetarians.

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Figure 1.

Serum vitamin B12 and folate concentration data from a cross-sectional study of Norwegian vegans and vegetarians, assessing adequacy of these micronutrients in plant-based populations.

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Tables

Table 1.

	Combined		Vegans		Vegetarians
	n	%	n	%	n	%	P †
Participants	205	100	115	56	90	44
Sex							0·005*
Females	148	72·2	74	64·3	74	82·2
Males	57	27·8	41	35·7	16	17·8
Country of origin							0·91
Norway	170	83·0	96	83·5	74	82·2
Other	35	17·0	19	16·5	16	17·8
Age (years)
Mean	30·4		31		29·6		0·09
sd	9·1		8·7		9·5
BMI (kg/m²)
Mean	23·2		23		23·4		0·64
sd	3·5		2·9		3·9
Educational level							0·65
< 12 years	6	2·9	3	2·6	3	3·3
12 years	36	17·6	22	19·1	14	15·6
1–4 years university	165	79·5	90	78·3	73	81·1
Smoking status							0·93
No	185	90·2	103	89·5	82	91·1
Yes	20	9·8	12	10·5	8	8·9
Duration of plant-based diet
Mean	4·7		4·11		5·5		0·007
sd	3·1		2·8		3·5
Supplement use
B₁₂, 24-h recall	120	58·5	70	60·9	50	55·6	0·45
B₁₂, habitual use	158	77·1	103	89·6	55	61·1	< 0·001*
Folate, habitual use	93	45·4	60	52·2	33	36·7	0·027

Table 2.

Intakes	Vegans		Vegetarians
	Median	IQR	Median	IQR	P †
B₁₂
24-h intake from food (µg/d)	0·04	0·00, 0·53	0·19	0·01, 0·50	0·57
Total 24-h intake (µg/d)	9·0	1·3, 25·1	6·3	0·50, 25·0	0·64
24-h intake below RDI
n	34		35		0·16
%	29·6		38·9
Habitual intake from food (µg/d)	0·39	0·17, 0·57	0·52	0·25, 0·74	0·005
Total habitual intake (µg/d)	10·6	2·4, 100	2·7	0·90, 10·4	0·001
Habitual intake < RDI
n	21		36		< 0·001
%	18·3		40·0
Injections
n	14		5		0·10
%	12·1		5·6
Time since last injection, months	9·8	4·4, 1–12	10·6	3·1, 5–12	0·80

Table 3.

	Combined		Vegans		Vegetarians
Markers	n	%	n	%	n	%	P †	Ref. values‡
B₁₂ (pmol/l)§
Median	357		350		359		0·88	150–650
IQR	270, 464		288, 450		255, 489
Deficient	14·3	29	12·4	14	16·7	15	0·43	< 221
Marginal	13·3	27	11·5	13	15·6	14	0·43	149–221
Severe	1·0	2	1·0	1	1·1	1	0·43	< 148
tHcy (µmol/l)\|\|
Median	9·0		9·0		8·4		0·25	5·0–15·0
IQR	7·1, 11·2		7·7, 11·0		6·4, 11·5
Elevated	7·0	14	5·3	6	9·1	8	0·44	> 15·0
MMA (µmol/l)¶
Median	0·18		0·2		0·2		0·55	< 0·27
IQR	0·15, 0·24		0·2, 0·3		0·1, 0·2
Elevated	19·0	37	19·3	21	16	18·6	0·70	> 0·27
Folate (nmol/l)**
Median	24·2		25·8		21·6		0·027	6–20
IQR	18·0, 32·9		20·3, 34·8		16·2, 31·3
Deficient	1·7	3	1·0	1	2·4	2	0·46	< 10·0
cB₁₂ ††
Median	1·30		1·31		1·29		0·11	0·5–1·5
IQR	1·24, 1·36		1·26, 1·36		1·23, 1·36
Elevated B₁₂	3·7	7	2·1	4	1·6	3	0·66	> 1·5

Table 4.

B₁₂ predictor	Unadjusted coefficient*	95 % CI	P	Adjusted coefficient†	95 % CI	P-value
Age	0·004	0·001, 0·006	0·008	0·19	0·001, 0·059	0·002
Supplement use‡	0·078	0·028, 0·13	0·003	0·21	0·013, 0·063	0·001

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B Folate (Vitamin B9) para Elevated Homocysteine (Hyperhomocysteinemia)

Adequate vitamin B12 and folate status of Norwegian vegans and vegetarians.

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