过多的叶酸和维生素B12缺乏:临床影响?
Joshua W Miller1, Andre Smith1, Aron M Troen2
1Rutgers University, New Brunswick, NJ, USA.
Food and nutrition bulletin
|July 10, 2024
概括
高剂量的叶酸补充剂可以掩盖和恶化维生素B12缺乏,特别是在高危人群中. 提高警对于在高叶酸摄入量的人群中识别维生素B12缺乏至关重要.
科学领域:
- 营养科学 营养科学
- 临床医学 临床医学
- 公共卫生 公共卫生
背景情况:
- 高剂量的叶酸 (>5 mg/d) 历史上掩盖了维生素B12缺乏性贫血.
- 目前的叶酸强化和补充引起了人们对加剧B12缺乏的担忧.
- 这个问题与恶性贫血和广泛使用叶酸有关.
研究的目的:
- 审查证据,将过多的叶酸与B12缺乏联系起来.
- 提出B12缺乏症恶化的机制的假设.
- 提供治疗B12缺乏症的临床指导.
主要方法:
- 对临床和流行病学证据的审查.
- 认知功能和生物标记数据 (homocysteine,甲基马龙酸) 的分析.
- 检查高剂量叶酸对特定患者群体B12水平的影响.
主要成果:
- 低B12和高叶酸的人表现出较差的认知功能和较高的生物标志物.
- 高剂量的叶酸在患有恶性贫血或的患者中显著降低血清B12.
- 假设:过多的叶酸会耗尽全转化胺,恶化B12缺乏.
结论:
- 有证据表明,过多的叶酸会加剧B12缺乏,尽管这一假设需要测试.
- 相对数据和临床观察值得谨慎使用.
- 临床医生应监测高叶酸摄入高风险人群B12缺乏.
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