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A Risk Group for Low Vitamin B₁₂ Concentration

Orit Pinhas-Hamiel, MD; Noa Doron-Panush, RD; Brian Reichman, MD; Dorit Nitzan-Kaluski, MD, MPH, RD; Shlomit Shalitin, MD; Liat Geva-Lerner, MD

Arch Pediatr Adolesc Med. 2006;160:933-936.

Objective  To assess whether overweight children and adolescents are at an increased risk for vitamin B₁₂ deficiency.

Design  Prospective descriptive study.

Setting  Two pediatric endocrine centers in Israel.

Participants  Three hundred ninety-two children and adolescents were divided into 2 groups as follows: the normal-weight group had body mass indexes, calculated as weight in kilograms divided by height in meters squared, under the 95th percentile (<1.645 standard deviation scores; n = 228); the obese group had body mass indexes equal to or above the 95th percentile (1.645 standard deviation scores; n = 164).

Intervention  We measured vitamin B₁₂ concentrations. Low serum B₁₂ was defined as a B₁₂ concentration less than 246 pg/mL, and vitamin B₁₂ deficiency was defined as a concentration below 211 pg/mL.

Main Outcome Measure  Vitamin B₁₂ concentrations corrected for body mass index standard deviation scores, age, and sex.

Results  Median concentration of serum B₁₂ in normal- weight children was 530 pg/mL and in obese children, 400 pg/mL (P<.001). Low B₁₂ concentrations were noted in 10.4% of the obese children compared with only 2.2% of the normal weight group (P<.001). Vitamin B₁₂ deficiency was noted in 12 children, 8 (4.9%) of the obese subjects and 4 (1.8%) of the normal weight group (P = .08). After we adjusted for age and sex, obesity was associated with a 4.3-fold risk for low serum B₁₂, and each unit increase in body mass index standard deviation score resulted in an increased risk of 1.24 (95% confidence interval, 0.99-1.56).

Conclusions  Obesity in children and adolescents was associated with an increased risk of low vitamin B₁₂ concentration. We recommend that dietary assessment of obese children should include an estimation of vitamin B₁₂ intake. The possibility of vitamin B₁₂ deficiency in addition to other micronutrient deficiencies should be considered in obese children.

Author Affiliations: Pediatric Endocrinology and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel (Dr Pinhas-Hamiel, Ms Doron-Panush, and Dr Reichman); Pediatric Endocrinology and Metabolism Unit, Schneider Children's Medical Center, Petah Tikva, Israel (Ms Doron-Panush and Dr Shatilin); Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer (Drs Reichman and Geva-Lerner); Food and Nutrition Administration and Department of Epidemiology and Preventive Medicine, Ministry of Health, Jerusalem, Israel (Dr Nitzan-Kaluski); and Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel (Dr Pinhas-Hamiel, Ms Doron-Panush, and Drs Reichman, Nitzan-Kaluski, Shalitin, and Geva-Lerner).