title: Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians.
abstract: BACKGROUND
  In India, most people adhere to a vegetarian diet, which may lead to cobalamin deficiency.
  
  
  OBJECTIVE
  The objective was to examine indicators of cobalamin status in Asian Indians.
  
  
  METHODS
  The study population included 204 men and women aged 27-55 y from Pune, Maharashtra, India, categorized into 4 groups: patients with cardiovascular disease (CVD) and diabetes, patients with CVD but no diabetes, patients with diabetes but no CVD, and healthy subjects. Data on medical history, lifestyle, and diet were obtained by interviews and questionnaires. Blood samples were collected for measurement of serum or plasma total cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine (tHcy) and hemetologic indexes.
  
  
  RESULTS
  MMA, tHcy, total cobalamin, and holoTC did not differ significantly among the 4 groups; therefore, the data were pooled. Total cobalamin showed a strong inverse correlation with tHcy (r = -0.59) and MMA (r = -0.54). Forty-seven percent of the subjects had cobalamin deficiency (total cobalamin <150 pmol/L), 73% had low holoTC (<35 pmol/L), 77% had hyperhomocysteinemia (tHcy >15 micromol/L), and 73% had elevated serum MMA (>0.26 micromol/L). These indicators of impaired cobalamin status were observed in both vegetarians and nonvegetarians. Folate deficiency was rare and only 2.5% of the subjects were homozygous for the MTHFR 677C-->T polymorphism.
  
  
  CONCLUSIONS
  About 75% of the subjects had metabolic signs of cobalamin deficiency, which was only partly explained by the vegetarian diet. If impaired cobalamin status is confirmed in other parts of India, it may have important health implications.
authors.affiliation: Department of Pharmacology and the Locus for Homocysteine and Related Vitamins, University of Bergen, Norway. helga.refsum@farm.uib.no
authors.forename: H
authors.initials: H
authors.lastname: Refsum
authors.forename: C S
authors.initials: CS
authors.lastname: Yajnik
authors.forename: M
authors.initials: M
authors.lastname: Gadkari
authors.forename: J
authors.initials: J
authors.lastname: Schneede
authors.forename: S E
authors.initials: SE
authors.lastname: Vollset
authors.forename: L
authors.initials: L
authors.lastname: Orning
authors.forename: A B
authors.initials: AB
authors.lastname: Guttormsen
authors.forename: A
authors.initials: A
authors.lastname: Joglekar
authors.forename: M G
authors.initials: MG
authors.lastname: Sayyad
authors.forename: A
authors.initials: A
authors.lastname: Ulvik
authors.forename: P M
authors.initials: PM
authors.lastname: Ueland
mesh_terms: D000328:Adult; D015415:Biomarkers; D002318:Cardiovascular Diseases / Q000097:blood / Q000503:physiopathology; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology; D014676:Diet, Vegetarian; D005260:Female; D005492:Folic Acid / Q000097:blood; D006710:Homocysteine / Q000097:blood*; D006801:Humans; D020138:Hyperhomocysteinemia / Q000097:blood*; D007194:India / Q000453:epidemiology; D008297:Male; D008764:Methylmalonic Acid / Q000097:blood*; D008875:Middle Aged; D015995:Prevalence; D011795:Surveys and Questionnaires; D014805:Vitamin B 12 / Q000097:blood*; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology
chemical_list: D015415:Biomarkers; D006710:Homocysteine; D008764:Methylmalonic Acid; D005492:Folic Acid; D014805:Vitamin B 12