title: Evaluation of indicators of cobalamin deficiency defined as cobalamin-induced reduction in increased serum methylmalonic acid.
abstract: BACKGROUND
  Early detection of cobalamin deficiency is clinically important, and there is evidence that such deficiency occurs more frequently than previously anticipated. However, serum cobalamin and other commonly used tests have limited ability to diagnose a deficiency state.
  
  
  METHODS
  We investigated the ability of hematological variables, serum cobalamin, plasma total homocysteine (tHcy), serum and erythrocyte folate, gastroscopy, age, and gender to predict cobalamin deficiency. Patients (n = 196; age range, 17-87 years) who had been referred from general practice for determination of serum cobalamin were studied. Cobalamin deficiency was defined as serum methylmalonic acid (MMA) >0.26 micromol/L with at least 50% reduction after cobalamin supplementation. ROC and logistic regression analyses were used.
  
  
  RESULTS
  Serum cobalamin and tHcy were the best predictors, with areas under the ROC curve (SE) of 0. 810 (0.034) and 0.768 (0.037), respectively, but age, intrinsic factor antibodies, and gastroscopy gave additional information.
  
  
  CONCLUSIONS
  When cobalamin deficiency is suspected in general practice, serum cobalamin should be the first diagnostic test, and the result should be interpreted in relation to the age of the patient. When a definite diagnosis cannot be reached, MMA and tHcy determination will provide additional discriminative information, but MMA, being more specific, is preferable for assessment of cobalamin status.
authors.affiliation: Laboratory of Clinical Biochemistry, Haukeland University Hospital, N-5021 Bergen, Norway. bjorn.bolann@ikb.uib.no
authors.forename: B J
authors.initials: BJ
authors.lastname: Bolann
authors.forename: J D
authors.initials: JD
authors.lastname: Solli
authors.forename: J
authors.initials: J
authors.lastname: Schneede
authors.forename: K A
authors.initials: KA
authors.lastname: Grøttum
authors.forename: A
authors.initials: A
authors.lastname: Loraas
authors.forename: M
authors.initials: M
authors.lastname: Stokkeland
authors.forename: A
authors.initials: A
authors.lastname: Stallemo
authors.forename: A
authors.initials: A
authors.lastname: Schjøth
authors.forename: R B
authors.initials: RB
authors.lastname: Bie
authors.forename: H
authors.initials: H
authors.lastname: Refsum
authors.forename: P M
authors.initials: PM
authors.lastname: Ueland
mesh_terms: D000293:Adolescent; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005492:Folic Acid / Q000097:blood; D005773:Gastroscopy; D006710:Homocysteine / Q000097:blood; D006801:Humans; D008297:Male; D008764:Methylmalonic Acid / Q000097:blood*; D008875:Middle Aged; D010084:Oxidation-Reduction; D012372:ROC Curve; D012044:Regression Analysis; D012737:Sex Factors; D014805:Vitamin B 12 / Q000097:blood*; D014806:Vitamin B 12 Deficiency / Q000175:diagnosis*
chemical_list: D006710:Homocysteine; D008764:Methylmalonic Acid; D005492:Folic Acid; D014805:Vitamin B 12