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Vitamin B12 treatment normalizes metabolic markers but has limited clinical effect: a randomized placebo-controlled
A M Hvas1, J Ellegaard, E Nexø
1Department of Hematology, AAS, Aarhus University Hospital, Tage Hansens Gade 2, 8000 Aarhus C, Denmark. am.hvas@dadlnet.dk
Background:
The clinical significance of increased plasma methylmalonic acid (P-MMA) is unclear. We assessed the efficacy of vitamin B12 treatment in reducing P-MMA and plasma total homocysteine compared with the clinical benefits of treatment.
Methods:
We studied 140 individuals with mildly to modestly increased P-MMA (0.40-2.00 micromol/L), not previously treated with vitamin B12, in a randomized, placebo-controlled study. A detailed medical history was obtained, and laboratory tests as well as an objective neurologic disability score were performed at baseline and 3 months after the start of intervention.
Results:
P-MMA (P <0.001) or plasma total homocysteine (P <0.001) decreased in the treatment group vs the placebo group, but no significant difference was found in the change of blood hemoglobin (P = 0.18) and mean cell volume (P = 0.71). Changes in symptom scores did not differ between the groups for symptoms of anemia (P = 0.63), neurologic symptoms (P = 0.21), gastroenterologic symptoms (P = 0.32), or the Neurological Disability Score (P = 0.85).
Conclusions:
Treatment with vitamin B12 reduces P-MMA and plasma total homocysteine, but individuals with a mild to modest increase in P-MMA may have only limited clinical benefit from vitamin B12 treatment, at least in the short term.
Insights
Vitamin B12 treatment effectively lowers elevated plasma methylmalonic acid (P-MMA) and homocysteine levels. However, the study found limited short-term clinical benefits for individuals with mild to modest P-MMA increases.
Area of Science:
- Biochemistry
- Clinical Nutrition
- Neurology
Background:
- The clinical relevance of elevated plasma methylmalonic acid (P-MMA) is not well-established.
- Assessing the impact of vitamin B12 on P-MMA and related clinical outcomes is crucial.
Purpose of the Study:
- To evaluate the effectiveness of vitamin B12 in reducing P-MMA and plasma total homocysteine.
- To compare the biochemical changes with clinical benefits in patients with elevated P-MMA.
Main Methods:
- A randomized, placebo-controlled study involving 140 participants with mildly to modestly increased P-MMA.
- Baseline and 3-month assessments included medical history, laboratory tests, and a neurological disability score.
Main Results:
- Vitamin B12 treatment significantly reduced P-MMA and plasma total homocysteine compared to placebo.
- No significant differences were observed in hemoglobin, mean cell volume, or various symptom scores between groups.
Conclusions:
- Vitamin B12 effectively lowers P-MMA and plasma total homocysteine.
- Clinical benefits from vitamin B12 treatment appear limited in the short term for individuals with mild to modest P-MMA elevations.