Why Food Fortification with Vitamin B12 Is Needed?
There are many articles indicating the increasing prevalence of low vitamin B12 (also called cobalamin) status in different segments of the general population [1–7]. The early detection of vitamin B12 deficiency is essential in order to prescribe opportune treatments, and there is evidence that such deficiencies are more common than would be expected. Vitamin B12 deficiency frequently occurs in individuals with dietary patterns that exclude animal food products and patients who are unable to absorb vitamin B12. Vitamin B12 deficiency has many causes, and pernicious anemia has been described as a widespread cause of this. Recent studies on vitamin B12, including the description of novel etiologies of vitamin B12 deficiency, have added to our understanding of this essential dietary component. For example, vitamin B12 deficiency can arise not only from insufficient dietary intake  but also from food-cobalamin malabsorption syndrome . The latter is characterized by the failure to release vitamin B12 from food or a deficiency of intestinal vitamin B12 transport proteins or both, due to chronic overgrowth of Helicobacter pylori  and intestinal microbial proliferation. Changes in gut flora can arise from antibiotic treatment, long-term ingestion of biguanides (metformin) [11, 12], and antacids, including H2-receptor antagonists and proton-pump inhibitors  (mainly among patients with Zollinger–Ellison syndrome ). There are also genetic vitamin B12 metabolism diseases as Imerslund–Grasbeck syndrome which is a selective vitamin B12 malabsorption with proteinuria . Chronic alcoholism, surgery (e.g., bypass surgery for obesity), and partial pancreatic exocrine failure can also contribute to vitamin B12 deficiency. Overall, this demonstrates that new approaches to the identification and treatment of subjects with vitamin B12 deficiency may be needed.
KeywordsVitamin B12 Cobalamin Vitamin B12 deficiency Vitamin B12 routine fortification Malignancy and vitamin B12 Quality of life
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