title: Vitamin B-12 status, particularly holotranscobalamin II and methylmalonic acid concentrations, and hyperhomocysteinemia in vegetarians.
abstract: BACKGROUND
  Vegetarians have a lower intake of vitamin B-12 than do omnivores. Early and reliable diagnosis of vitamin B-12 deficiency is very important.
  
  
  OBJECTIVE
  The objective was to investigate vitamin B-12 status in vegetarians and nonvegetarians.
  
  
  METHODS
  The study cohort included 66 lactovegetarians or lactoovovegetarians (LV-LOV group), 29 vegans, and 79 omnivores. Total vitamin B-12, methylmalonic acid, holotranscobalamin II, and total homocysteine concentrations were assayed in serum.
  
  
  RESULTS
  Of the 3 groups, the vegans had the lowest vitamin B-12 status. In subjects who did not consume vitamins, low holotranscobalamin II (< 35 pmol/L) was found in 11% of the omnivores, 77% of the LV-LOV group, and 92% of the vegans. Elevated methylmalonic acid (> 271 nmol/L) was found in 5% of the omnivores, 68% of the LV-LOV group, and 83% of the vegans. Hyperhomocysteinemia (> 12 micromol/L) was present in 16% of the omnivores, 38% of the LV-LOV group, and 67% of the vegans. The correlation between holotranscobalamin II and vitamin B-12 was weak in the low serum vitamin B-12 range (r = 0.403) and strong in the high serum vitamin B-12 range (r = 0.769). Holotranscobalamin II concentration was the main determinant of total homocysteine concentration in the vegetarians (beta = -0.237, P < 0.001). Vitamin B-12 deficiency led to hyperhomocysteinemia that was not probable in the upper folate range (> 42.0 nmol/L).
  
  
  CONCLUSIONS
  Vegan subjects and, to a lesser degree, subjects in the LV-LOV group had metabolic features indicating vitamin B-12 deficiency that led to a substantial increase in total homocysteine concentrations. Vitamin B-12 status should be monitored in vegetarians. Health aspects of vegetarianism should be considered in the light of possible damaging effects arising from vitamin B-12 deficiency and hyperhomocysteinemia.
authors.affiliation: Central Laboratory, Department of Clinical Chemistry, Saarland University Hospital, Homburg, Germany. kchwher@uniklinik-saarland.de
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Herrmann
authors.forename: Heike
authors.initials: H
authors.lastname: Schorr
authors.forename: Rima
authors.initials: R
authors.lastname: Obeid
authors.forename: Jürgen
authors.initials: J
authors.lastname: Geisel
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D014676:Diet, Vegetarian; D005260:Female; D005492:Folic Acid / Q000097:blood; D006710:Homocysteine / Q000097:blood; D006801:Humans; D020138:Hyperhomocysteinemia / Q000209:etiology*; D008297:Male; D008764:Methylmalonic Acid / Q000097:blood*; D008875:Middle Aged; D009994:Osmolar Concentration; D014155:Transcobalamins / Q000032:analysis*; D014805:Vitamin B 12 / Q000097:blood*
chemical_list: D015415:Biomarkers; D014155:Transcobalamins; D006710:Homocysteine; D008764:Methylmalonic Acid; D005492:Folic Acid; D014805:Vitamin B 12