Association between vitamin B₁₂-containing supplement consumption and prevalence of biochemically defined B₁₂ deficiency in adults in NHANES III (Third National Health and Nutrition Examination Survey)

Abstract

Objective: To explore the association between vitamin B 12 (B 12 )-containing supplement use, low B 12 concentrations and biochemically defined B 12 deficiency in US adults. Design: A cross-sectional study with adjustment for survey design. Prevalence ratios for two age groups (18-50 and .50 years) were estimated using unconditional logistic models. Outcome measures included prevalence of low serum B 12 concentration (,148 pmol/l) and biochemical B 12 deficiency (serum B 12 , 148 pmol/l with concomitant homocysteine . 10 mmol/l). Setting: A population survey of health and nutritional measures. Subjects: Subjects were non-institutionalized adults, aged 18 years and older, who participated in Phase 2 of NHANES III (Third National Health and Nutrition Examination Survey). Results: Low B 12 concentrations were less prevalent among persons consuming B 12 -containing supplements (P 5 0?001) with an adjusted prevalence ratio of 0?6 (95 % CI 0?3, 1?0). Biochemical B 12 deficiency showed a similar trend (P 5 0?0002), with an adjusted prevalence ratio of 0?3 (95 % CI 0?1, 0?8). Prevalence ratios were similar in adults .50 years of age, although the prevalence of low B 12 and biochemical deficiency was proportionally higher. Conclusions: Consumption of B 12 -containing supplements was associated with at least 50 % lower prevalence of both low serum B 12 and biochemical B 12 deficiency in a nationally representative sample of US adults, suggesting increased consumption of B 12 from supplements or from fortified foods may reduce the prevalence of B 12 deficiency. Additionally, the current Recommended Daily Allowance for B 12 of 2?4 mg may be insufficient for those aged .50 years. The Institute of Medicine (IOM) extensively reviewed the available data on vitamin B 12 (B 12 ) deficiency and requirements, and has identified biochemical B 12 deficiency and effective methods to reduce risk of B 12 deficiency as high priorities for research (1) . The Recommended Daily Allowance (RDA) was set at 120 % of the daily requirement and is expected to protect 97-98 % of healthy persons from deficiency. Based on the lower bioavailability of food-bound B 12 in older individuals, the IOM recommended adults over the age of 50 years meet the RDA for B 12 of 2?4 mg by consuming synthetic vitamin B 12 in B 12 -fortified foods or B 12 supplements (1) . Previously, three population-based studies examined biochemical indicators of B 12 deficiency (serum B 12 and/or homocysteine and methylmalonic acid (MMA) concentrations) in relation to vitamin supplement status and concluded that B 12 -containing supplements may protect against B 12 deficiency

Folic acid source, usual intake, and folate and vitamin B-12 status in US adults: National Health and Nutrition Examination Survey (NHANES) 2003–2006

“…Because the vast majority of RTE and supplements with folic acid also contain vitamin B-12, consumption may reduce the risk of vitamin B-12 deficiency among older adults. As did another recent report (30), our data suggest that US adults aged 60 y who do not consume supplements with vitamin B-12 may be at increased risk of vitamin B-12 deficiency, even those with median usual vitamin B-12 intakes of '3 lg/d from RTE (greater than the Recommended Dietary Allowance of 2.4 lg/d) (7).…”

“…As recommended by the Institute of Medicine, persons aged 51 y should consume the required amount of vitamin B-12 from synthetic sources (7). Our results and others (30) suggest that further investigation of the average daily amount of synthetic vitamin B-12 required to prevent deficiency among older adults is warranted. The authors' responsibilities were as follows-QY and MEC: had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis; QY, MEC, LBB, and RJB: study concept and design; QY, MEC, HCH, AC, RJB, CMP, and LBB: analysis and interpretation of data and critical revision of the manuscript for important intellectual content; QY and MEC: draft of manuscript; QY, AC, and MEC: statistical analysis; and QY: study supervision.…”

Dietary Supplement Use and Smoking Are Important Correlates of Biomarkers of Water-Soluble Vitamin Status after Adjusting for Sociodemographic and Lifestyle Variables in a Representative Sample of U.S. Adults

“…Data for all sociodemographic variables (age, sex, race-ethnicity, income, and education) and several lifestyle variables (alcohol consumption, physical activity level, and supplement use) used in our analysis were self-reported. For bivariate analyses, we categorized the variables as follows: age (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50)(51)(52)(53)(54)(55)(56)(57)(58)(59), and $60 y), sex (men and women), race-ethnicity [Mexican American (MA), non-Hispanic black (NHB), and non-Hispanic white (NHW)], education (less than high school, high school, and more than high school), family poverty-income ratio [PIR; 0-1.85 (low), >1.85-3.5 (medium), and >3. 5 (44), physical activity (total metabolic equivalent task minutes/wk from leisure-time physical activity: none reported, 0 to <500, 500 to <1000, and $1000) (45), and supplement use [reported taking a dietary supplement within the past 30 d: yes (user), no (nonuser)].…”

“…Data from national nutrition surveys in the US, the United Kingdom, Canada, and Mexico have shown that socioeconomic status and/or lifestyle variables are related to nutritional biomarkers ( Table 1). Most of these studies were limited in scope, investigating the influence of 1 or few variables on 1 or 2 biomarkers (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). Few studies have assessed the relationship of multiple biomarkers with socioeconomic variables (31,32), smoking (33), alcohol consumption (34), or BMI (35,36).…”

Vitamin B12 among Vegetarians: Status, Assessment and Supplementation

“…Supplements have been demonstrated as efficient in the restoration of Cbl blood concentration [97,138]. Currently, the official position of associations and government agencies is categorical and unequivocal: in the case of a vegetarian diet, including LOV, LV and OV, supplementation of Cbl is required [11,13].…”