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Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery.
Ann Intern Med. 1996 Mar 01; 124(5):469-76.AIM

Abstract

OBJECTIVE

To determine the prevalence of vitamin B12 deficiency in patients who have had gastric surgery.

DESIGN

Cross-sectional study.

SETTING

Philadelphia Veterans Affairs Medical Center.

PARTICIPANTS

61 patients who had had gastric surgery and 107 controls.

MEASUREMENTS

Serum levels of vitamin B12, folate, methylmalonic acid, and total homocysteine measured before and after treatment in participants with vitamin B12 deficiency. Vitamin B12 deficiency was defined as one of the following: 1) a serum vitamin B12 level less than 221 pmol/L and an elevated methylmalonic acid level; 2) a serum vitamin B12 level less than 221 pmol/L and an elevated total homocysteine level that decreased with vitamin B12 treatment; or 3) in patients unavailable for treatment, a serum vitamin B12 level less than 221 pmol/L, a folate level greater than 9 nmol/L, and an elevated total homocysteine level.

RESULTS

Study patients and controls were similar in age, sex, and racial distribution. Nineteen patients (31%) and 2 controls (2%) had vitamin B12 deficiency (P < 0.001). Twelve (63%) of the 19 vitamin B12-deficient patients had elevated total homocysteine levels. In all participants with vitamin B12 deficiency who received treatment (15 of 21), methylmalonic acid and total homocysteine levels decreased substantially, confirming the deficiency before treatment.

CONCLUSION

Patients who have had gastric surgery have a high prevalence of vitamin B12 deficiency. Prompt recognition and treatment of the deficiency with resultant normalization of elevated total homocysteine and methylmalonic acid levels may prevent the development of cardiovascular, hematologic, and neurologic abnormalities. Our data support both frequent screening and vitamin B12 replacement therapy in patients who have had gastric surgery and have serum vitamin B12 levels less than 221 pmol/L.

Authors+Show Affiliations

Philadelphia Veterans Affairs Medical Center, Pennsylvania, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

8602704

Citation

Sumner, A E., et al. "Elevated Methylmalonic Acid and Total Homocysteine Levels Show High Prevalence of Vitamin B12 Deficiency After Gastric Surgery." Annals of Internal Medicine, vol. 124, no. 5, 1996, pp. 469-76.
Sumner AE, Chin MM, Abrahm JL, et al. Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. Ann Intern Med. 1996;124(5):469-76.
Sumner, A. E., Chin, M. M., Abrahm, J. L., Berry, G. T., Gracely, E. J., Allen, R. H., & Stabler, S. P. (1996). Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. Annals of Internal Medicine, 124(5), 469-76.
Sumner AE, et al. Elevated Methylmalonic Acid and Total Homocysteine Levels Show High Prevalence of Vitamin B12 Deficiency After Gastric Surgery. Ann Intern Med. 1996 Mar 1;124(5):469-76. PubMed PMID: 8602704.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Elevated methylmalonic acid and total homocysteine levels show high prevalence of vitamin B12 deficiency after gastric surgery. AU - Sumner,A E, AU - Chin,M M, AU - Abrahm,J L, AU - Berry,G T, AU - Gracely,E J, AU - Allen,R H, AU - Stabler,S P, PY - 1996/3/1/pubmed PY - 1996/3/1/medline PY - 1996/3/1/entrez SP - 469 EP - 76 JF - Annals of internal medicine JO - Ann Intern Med VL - 124 IS - 5 N2 - OBJECTIVE: To determine the prevalence of vitamin B12 deficiency in patients who have had gastric surgery. DESIGN: Cross-sectional study. SETTING: Philadelphia Veterans Affairs Medical Center. PARTICIPANTS: 61 patients who had had gastric surgery and 107 controls. MEASUREMENTS: Serum levels of vitamin B12, folate, methylmalonic acid, and total homocysteine measured before and after treatment in participants with vitamin B12 deficiency. Vitamin B12 deficiency was defined as one of the following: 1) a serum vitamin B12 level less than 221 pmol/L and an elevated methylmalonic acid level; 2) a serum vitamin B12 level less than 221 pmol/L and an elevated total homocysteine level that decreased with vitamin B12 treatment; or 3) in patients unavailable for treatment, a serum vitamin B12 level less than 221 pmol/L, a folate level greater than 9 nmol/L, and an elevated total homocysteine level. RESULTS: Study patients and controls were similar in age, sex, and racial distribution. Nineteen patients (31%) and 2 controls (2%) had vitamin B12 deficiency (P < 0.001). Twelve (63%) of the 19 vitamin B12-deficient patients had elevated total homocysteine levels. In all participants with vitamin B12 deficiency who received treatment (15 of 21), methylmalonic acid and total homocysteine levels decreased substantially, confirming the deficiency before treatment. CONCLUSION: Patients who have had gastric surgery have a high prevalence of vitamin B12 deficiency. Prompt recognition and treatment of the deficiency with resultant normalization of elevated total homocysteine and methylmalonic acid levels may prevent the development of cardiovascular, hematologic, and neurologic abnormalities. Our data support both frequent screening and vitamin B12 replacement therapy in patients who have had gastric surgery and have serum vitamin B12 levels less than 221 pmol/L. SN - 0003-4819 UR - https://www.unboundmedicine.com/medline/citation/8602704/Elevated_methylmalonic_acid_and_total_homocysteine_levels_show_high_prevalence_of_vitamin_B12_deficiency_after_gastric_surgery_ L2 - https://www.acpjournals.org/doi/10.7326/0003-4819-124-5-199603010-00002?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -