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Keynote Manuscript Prof. Ralph Green: ‘Causes and Risk Factors of Vitamin B12 Deficiency at the Bookends of Life, From Infancy to Old Age’

The keynote manuscript by Ralph Green, MD, PhD, from the University of California, Davis, provides a comprehensive overview of the causes and risk factors of Vitamin B12 deficiency across the lifespan. It begins by acknowledging the historical significance of Vitamin B12 in curing pernicious anemia. This condition previously had a dire prognosis, and highlights the Nobel Prize-winning work that led to this discovery. Contrary to earlier beliefs that B12 deficiency was mainly a concern for the elderly, Green points out that it can affect individuals at any age and is a significant cause of morbidity among children and young adults in certain regions.

Figure 1. Kaplan-Meier survival curve of 321 patients with pernicious anemia, generated from the publication by Cabot (1908).⁵ The median survival was less than 20 months, and the 5-year survival was less than 10 percent.

A special tribute is paid to Dorothy Crowfoot Hodgkin, a Nobel Prize laureate for her work on the structure of the B12 molecule. Her personal struggle with rheumatoid arthritis and her determination to continue her research despite severe physical limitations are described, underscoring the human element behind scientific discovery.

The manuscript delves into the complex mechanisms involved in B12 absorption, protection, and metabolism, emphasizing the importance of understanding these processes to grasp how B12 deficiency can occur. It is noted that B12 is essential for only two biochemical reactions in humans but is crucial for health, influencing homocysteine and methylmalonate levels in the plasma, which are linked to various health issues, including cardiovascular disease and cognitive decline.

Various factors determining B12 adequacy are discussed, such as dietary intake, the integrity of the absorption mechanism, and the role of the microbiome. The causes of B12 deficiency are categorized into inadequate intake, malabsorption, and miscellaneous causes, with specific attention to the impact of diet, particularly in vegetarian and vegan populations, and the various diseases and conditions that can impair B12 absorption.

Green also highlights the wide range of clinical manifestations of B12 deficiency, from hematological to neurological complications, and the shift in the frequency of these manifestations over time. The narrative includes intriguing case studies that illustrate the atypical and diverse presentations of B12 deficiency, emphasizing the importance of maintaining a high index of suspicion for this condition.

In conclusion, the manuscript stresses the complexity of B12 deficiency, its varied etiologies, and its potential impact on health across the lifespan. It calls for heightened awareness and a proactive approach to diagnosis and treatment to mitigate the consequences of this deficiency.

Leading authorities on Vitamin B12 deficiency publish a comprehensive supplement addressing B12 deficiency across all stages of life.

Download Press Release here

Download Complete Access Free Supplement here: 

‘Vitamin B12 Deficiency in Clinical Practice: Scientific Insights at the Bookends of Life-Proceedings of the First International B12 Conference, June 2023, Rotterdam’ is an 88-page supplement published by the Food and Nutrition Bulletin 2024/June.

It contains 14 peer-reviewed manuscripts guest edited by hematologist/clinical pathologist Prof. Ralph Green (University of California, Davis) and co-organizer of the B12 Conference, Clara Plattel (B12 Institute, Rotterdam). This publication summarizes the latest research, case studies, critical insights, and practical tools by B12 experts from leading universities around the world, delving into the diagnosis, treatment, and implications of Vitamin B12 deficiency from pregnancy to old age.
In his keynote manuscript, Prof. Green provides a comprehensive insight into the causes and risk factors of Vitamin B12 deficiency across the human life cycle. He sets the stage for a detailed exploration of the multifaceted aspects of B12 deficiency (the “master of disguises”), highlighting the conference’s key discussion points and emphasizing the importance of a multidisciplinary approach to addressing this issue.

TOPICS

B12 Deficiency in Pregnancy, Infants, and Adolescents
• Early Development Impacts: Santos-Calderón et al. discuss the critical effects of B12 deficiency during early development, stressing its long-term
impacts on offspring. The paper calls for further research considering the rising popularity of plant-based diets.
• Neurodevelopment in Infancy: Bjørke-Monsen highlights the essential role of optimal B12 levels in neurodevelopment during infancy, indicating
significant consequences of deficiency during this crucial stage of the life cycle.
• Diagnosis and Treatment in Children: Plattel et al. emphasize the need for revised diagnostic parameters and treatment options tailored for children
and adolescents to address B12 deficiency more effectively in the pediatric age group.

Diagnosis and Treatment of B12 Deficiency in Adults
• Biomarkers for Diagnosis: Nexo et al. focus on using Vitamin B12 biomarkers to improve the diagnosis and management of B12 deficiency in adults.
• Pernicious Anemia Symptoms: Seage et al. provide a systematic review of the symptoms associated with pernicious anemia, a condition causing profound B12 deficiency through malabsorption.
• Advances in Management: Wolffenbuttel et al. detail recent advances in diagnostic methodologies and treatment options, aiming to enhance the management of B12 deficiency in the adult population.

B12 Deficiency and Cognitive Decline in the Elderly
• Cognitive Impairment Link: Rosenberg examines the connection between B12 deficiency and cognitive impairment in older adults, emphasizing the importance of prevention and targeted treatment strategies.
• Case Study: Dekker et al. present a case study that illustrates the practical implications of B12 deficiency on cognitive function in the elderly, reinforcing the need for attentive management.

Risk Factors and Current Guidelines in B12 Deficiency
• High Folic Acid Impact: Miller et al. explore the impact of high folic acid supplement intake in the presence of B12 deficiency, discussing mechanisms
and potential complications in such scenarios.
• Vegetarian and Vegan Diets: Hannibal et al. investigate the relationship between B12 deficiency and vegetarian or vegan diets, highlighting the
nutritional risks associated with exclusively plant-based eating habits.
• Patient Monitoring: Suijker et al. emphasize the importance of patient monitoring outcomes in both research and diagnosis of B12 deficiency.
• Guideline Revisions: Plattel calls for substantial revisions to current B12 deficiency guidelines, citing a lack of robust clinical evidence supporting
existing recommendations.

Editors’ Note about the significance of the supplement
This supplement aims to foster a multidisciplinary approach to better understand and address Vitamin B12 deficiency, a significant global health problem affecting all ages. Broad and varied contributions by experts highlight the complexity of diagnosing and treating B12 deficiency and underscore the need
for heightened awareness and improved clinical practices. With a paucity of relevant clinical trials, critical input on guidelines (diagnosis and management) from clinical and research experts and patients is essential.

Availability
The supplement is available through the Food and Nutrition Bulletin, trough this link and thanks to generous donor financial support, healthcare professionals, academic institutions, patients, and those involved in public health policy can access it FREE of charge.
Contact Information
For more details, interviews, or further inquiries, please contact press@b12conference.nl

About the Food and Nutrition Bulletin
The Food and Nutrition Bulletin is a leading peer-reviewed journal focused on addressing global nutrition and food policy issues. Through publications like this supplement, it aims to foster informed health decisions and effective public health strategies.

This press release is intended for healthcare professionals, academic institutions, and journalists to spread awareness and encourage further research and discussion on this critical health topic. It invites the global health community to explore this significant publication, which aims to enhance understanding
and improve health outcomes related to Vitamin B12 deficiency across the lifespan.

Announcement:

One year ago, the ‘First International Conference on B12 Deficiency in Clinical Practice’ kicked off in Rotterdam. ‘B12 at the bookends of Life’. B12 issues covering issues from infancy to old age.

The aim of this conference was to share clinically relevant research and expertise between international experts in the field.

The conference brought together experts from different fields, including physicians/specialists, scientists, representatives of patient groups and healthcare professionals, all experts in the field of vitamin B12. Topics included discussion and debate on the complexities of diagnosis and treatment of Vitamin B12 deficiency.

Representatives from several universities around the world participated and shared their latest research. Case histories were presented which directly related to the clinical features and research presented on a particular topic. Patients also featured prominently and made presentations on financial aspects (health insurance companies and personal costs), symptom complexes and delays in receiving a diagnosis. This format will serve as a template for future such meetings.

We announced last year that a peer-reviewed collection of many of the presentations would be published together as a supplement by the scientific journal: Food and Nutrition Bulletin, June 2024. https://journals.sagepub.com/home/fnb

We are pleased to announce that the supplement, containing 14 peer-reviewed manuscripts, has entered the production phase.

The content of the supplement covers a variety of topics, from the latest research findings to case studies from various medical disciplines. The purpose of the supplement is, to distill the knowledge of the conference into an accessible format for physicians and scientists. The supplement emphasizes the need for a comprehensive and multidisciplinary approach to tackling vitamin B12 deficiency by bringing together insights from different perspectives and several disciplines.

Our aim is to contribute to improved awareness regarding the diagnosis and treatment of vitamin B12 deficiency and thereby improve the health and well-being of patients. Whether at the beginning or end of life and all ages in between, it is our hope that adequately addressing B12 deficiency can significantly improve overall health and quality of life for patients of all ages around the world.

The supplement containing all 14 articles (including our Introduction), will soon be available for download through FREE ACCESS. As soon as it is, we will let you know.

Warm regards,

Prof. Ralph Green, (Keynote speaker and meeting co-organizer B12 Conference

Clara Plattel (Meeting organizer B12 Conference)

Guest-Editors

Announcement in Sage Publishers: https://journals.sagepub.com/doi/10.1177/03795721221140233