Document Detail


Mandatory fortification of the food supply with cobalamin: an idea whose time has not yet come.
MedLine Citation:
PMID:  20577903     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The success of folic acid fortification has generated consideration of similar fortification with cobalamin for its own sake but more so to mitigate possible neurologic risks from increased folate intake by cobalamin-deficient persons. However, the folate model itself, the success of which was predicted by successful clinical trials and the known favorable facts of high folic acid bioavailability and the infrequency of folate malabsorption, may not apply to cobalamin fortification. Cobalamin bioavailability is more restricted than folic acid and is unfortunately poorest in persons deficient in cobalamin. Moreover, clinical trials to demonstrate actual health benefits of relevant oral doses have not yet been done in persons with mild subclinical deficiency, who are the only practical targets of cobalamin fortification because >94% of persons with clinically overt cobalamin deficiency have severe malabsorption and therefore cannot respond to normal fortification doses. However, it is only in the severely malabsorptive disorders, such as pernicious anemia, not subclinical deficiency, that neurologic deterioration following folic acid therapy has been described to date. It is still unknown whether mild deficiency states, which usually arise from normal absorption or only food-bound cobalamin malabsorption, have real health consequences or how often they progress to overt clinical cobalamin deficiency. Reports of cognitive or other risks in the common subclinical deficiency state, although worrisome, have been inconsistent. Moreover, their observational nature proved neither causative connections nor documented health benefits. Extensive work, especially randomized clinical trials, must be done before mandatory dietary intervention on a national scale can be justified.
Authors:
Ralph Carmel
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Publication Detail:
Type:  Evaluation Studies; Journal Article; Research Support, N.I.H., Extramural; Review     Date:  2010-06-25
Journal Detail:
Title:  Journal of inherited metabolic disease     Volume:  34     ISSN:  1573-2665     ISO Abbreviation:  J. Inherit. Metab. Dis.     Publication Date:  2011 Feb 
Date Detail:
Created Date:  2011-01-25     Completed Date:  2011-05-12     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  7910918     Medline TA:  J Inherit Metab Dis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  67-73     Citation Subset:  IM    
Affiliation:
Department of Medicine, New York Methodist Hospital, Brooklyn, NY, 11215, USA. rac9001@nyp.org
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MeSH Terms
Descriptor/Qualifier:
Anemia, Pernicious / prevention & control
Dietary Supplements / standards,  utilization*
Food Supply* / standards
Health Plan Implementation / organization & administration*,  standards,  utilization
Humans
Mandatory Programs / organization & administration*,  utilization
Vitamin B 12 / administration & dosage,  therapeutic use*
Vitamin B 12 Deficiency / diet therapy*,  drug therapy
Grant Support
ID/Acronym/Agency:
DK32640/DK/NIDDK NIH HHS; R01 DK032640-19/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
68-19-9/Vitamin B 12
Comments/Corrections

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