Neurologic Aspects of Cobalamin Deficiency

Healton, Edward B.; Savage, David G.; Brust, John C.M.; Garrett, T. J.; Lindenbaum, John

doi:10.1097/00005792-199107000-00001

Cited by 661 publications

(542 citation statements)

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“…The conventional cutoff used to define deficient serum vitamin B 12 is 150 pmol/l. Below this concentration, individuals are at increased risk of the haematological and neurological complications of vitamin B 12 deficiency (Healton et al, 1991). Cutoffs for serum vitamin B 12 higher than 150 pmol/l have been suggested based on the finding that serum metabolites, such as total homocysteine and methylmalonic acid, are frequently elevated at vitamin B 12 concentrations above 150 pmol/l (Allen & Casterline, 1994).…”

Section: Discussionmentioning

confidence: 99%

Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders

et al. 2004

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Objective: To determine the serum vitamin B 12 status of older New Zealanders and to assess the impact of atrophic gastritis on vitamin B 12 status. Design: A cross-sectional nationally representative population-based survey. Method: Serum vitamin B 12 concentrations were used to assess vitamin B 12 status. The presence and severity of atrophic gastritis was classified using serum pepsinogen I and II. Subjects: A total of 466 noninstitutionalized urban and rural dwelling New Zealanders aged 65 y or older who participated in the 1997 National Nutrition Survey. Results: The prevalence of deficient (o148 pmol/l) and marginal (148-221 pmol/l) serum vitamin B 12 concentrations was 12 and 28%, respectively. The prevalence of atrophic gastritis was 6.7% (severe 3.1%, mild-moderate 3.6%). While atrophic gastritis increased the relative risk (RR, 95% CI) of having a deficient or marginal serum vitamin B 12 concentration by 21-fold (6-67) and five-fold (1-17), respectively, those who had atrophic gastritis made up only 33 and 6% of the participants with deficient or marginal serum vitamin B 12 concentrations. An intake of vitamin B 12 from food that exceeded the recommended dietary allowance (2.4 mg/day) did not protect against deficient (RR 0.5; 95% CI: 0.2, 1.2) or marginal (RR 0.9; 95% CI: 0.5, 1.7) serum vitamin B 12 status. Vitamin B 12 supplement users had a reduced risk of having deficient and marginal vitamin B 12 status (RR 0.3; 95% CI: 0.1, 0.8).Conclusions: There is a relatively high prevalence of deficient and marginal serum vitamin B 12 concentrations among older New Zealanders. However, the prevalence of atrophic gastritis was low in the New Zealand elderly compared with other surveys. Although atrophic gastritis was a risk factor for low vitamin B 12 status, it did not fully explain the prevalence of low serum vitamin B 12 .

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Section: Discussionmentioning

confidence: 99%

Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders

et al. 2004

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“…Folate and vitamin B 12 status, particularly in the elderly, is currently the subject of considerable debate, primarily Iron, folate and vitamin B 12 status KE Charlton et al because re®ned biochemical techniques estimate the prevalence of tissue de®ciency, without the presence of anaemia, to be higher than the prevalence detected by measuring serum or blood cell concentration of the vitamins (Joosten et al, 1993;Lindenbaum et al, 1994); such suboptimal status at the biochemical level has been associated with signi®cant neuropsychiatric damage including impairment in cognitive function Healton et al, 1991). Moreover, similar suboptimal status of both vitamins, together with vitamin B 6 , has been associated with elevated serum homocysteine concentration (Stabler et al, 1988), the latter being increasingly accepted as an independent and major risk factor for coronary, peripheral and cerebrovascular disease (Clarke et al, 1991;Kang et al, 1992).…”

Section: Discussionmentioning

confidence: 99%

Iron, folate and vitamin B12 status of an elderly South African population

et al. 1997

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Objectives: To determine the prevalence of anaemia and the haemopoietic nutrient status of older mixed ancestry (coloured) South Africans. Design: A cross-sectional analytic study. Subjects: A random sample of 200 non-institutionalized subjects aged ! 65 y of age, resident in urban Cape Town, was drawn using a two-stage cluster design. Methods: Trained ®eldworkers interviewed subjects to obtain demographic and lifestyle data. Dietary intake was assessed using a validated food frequency questionnaire. Fasting blood samples were drawn for the determination of haematological parameters, serum vitamin B 12 , serum folate, RBC folate and a full blood count. Results: The prevalence of anaemia was 13.9. Eight of the 26 cases of anaemia (31) were associated with suboptimal haemopoietic nutrient status; 2(25) and 3(38) cases of these 8 anaemic subjects had suboptimal vitamin B 12 and folate status, respectively. Iron de®ciency anaemia accounted for 5(63) of the subjects with nutrition-related anaemia. Ten men and two women (6.5 of subjects) had raised serum ferritin concentrations, half of whom had abnormal biochemical parameters indicative of alcohol abuse. Conclusions: Older coloured South Africans, particularly women, should be encouraged to eat diets with a high nutrient density and to consume adequate amounts of foods high in iron, folate and vitamin B 12 . Further investigation regarding the high prevalence of hyperferritinaemia found in the men in this population is indicated. Sponsorship: Financial assistance from the HSRC/UCT Centre for Gerontology, the South African Sugar Association, the Zerilda Steyn Memorial Trust and the Medical Research Council (DL) for this project is acknowledged.

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“…Patients with hypocobalaminemia may present with pernicious anemia, characterized by megaloblastic anemia, gastrointestinal symptoms, and potentially irreversible neurological symptoms including peripheral neuropathy, loss of positional and vibrational sense, ataxia, seizures, and dementia (58,59). The risk of hypocobalaminemia is thought to increase approximately 5 years after augmentation and continues to escalate over time (60,61).…”

Section: Vitamin B12 Deficiencymentioning

confidence: 99%

Long-Term Sequela of Pediatric Bladder Reconstruction

Roth

Keenan

Cain

et al. 2015

Curr Bladder Dysfunct Rep

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Children with refractory neurogenic bladder (NGB) who have failed maximal medical management are presented with options for bladder reconstruction. It is critical to understand the long-term sequela of bladder augmentation and bladder neck reconstruction to properly counsel families regarding these procedures. Benefits may include preservation of renal function, continence, reduced risk of renal-related mortality and potential improvements in quality of life (QOL). However, these advantages must be balanced with the risks of bladder calculi, perforation, need for additional surgery, acid/base disturbances, vitamin B12 deficiency and malignancy. Therefore, careful patient selection and preoperative counseling are paramount for those undergoing bladder reconstruction which includes intestinal bladder augmentation, as these patients require lifelong vigilant follow-up. IntroductionChildren with neurogenic bladders (NGB) are initially managed with clean intermittent catheterization (CIC) and anticholinergic medications in order to maintain a sizable, continent, and compliant urinary reservoir. Despite early and aggressive intervention, some patients undergo lower urinary tract reconstruction (bladder augmentation, catheterizable channel and/or bladder neck reconstruction) to protect their upper tracts and achieve continence. In a few select patients with favorable urodynamics (UDS) and low outlet resistance, a bladder neck procedure (BNP) can be performed without bladder augmentation to achieve continence. Myelodysplasia, specifically spina bifida (SB), remains the most common etiology of NGB in the pediatric population. Due to medical advances, particularly in the realm of Urology, more SB patients with bladder reconstruction are surviving into adulthood. We review current literature regarding long-term sequela of bladder reconstruction in pediatric patients with neurogenic bladder, with a primary focus on bladder augmentations for refractory NGB secondary to SB.

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Neurologic Aspects of Cobalamin Deficiency

Cited by 661 publications

References 0 publications

Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders

Serum vitamin B12 concentrations and atrophic gastritis in older New Zealanders

Iron, folate and vitamin B12 status of an elderly South African population

Long-Term Sequela of Pediatric Bladder Reconstruction

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