Expert Perspectives on Diagnosis and Management of Vitamin B₁₂ Deficiency in Adults.

Identificador:  imarina:9597749

Handle: https://hdl.handle.net/20.500.11797/imarina9597749

Autors:  Guéant JL; Alpers DH; Allen LH; Andres E; Devlin AM; Green A; Green R; Guéant Rodriguez RM; Hannibal L; Harrington D; Mason JB; McCaddon A; Miller JW; Murphy M; Nexo E; McNulty H; Owen PJ; Quadros E; Rosenblatt D; Refsum H; Rietsema W; Stabler S; Ward M; Yajnik C; Finkelstein JL

Resum:
There is no universally-accepted definition of vitamin B₁₂ deficiency despite the severity of its medical consequences if not properly diagnosed and treated. B₁₂ deficiency can arise either from inadequate dietary intake, in particular in vegans/vegetarians, or various causes of impaired uptake/availability. The latter include H. pylori and auto-immune gastritis, other causes of malabsorptions and drug side effects. Vitamin B₁₂ deficiency can display diverse clinical signs and symptoms, including hematological, neurological, psychiatric and thromboembolic manifestations. The minutes and conclusions of three workshops at the FASEB "B-Vitamins and One Carbon Metabolism" Scientific Research Conferences (2022, 2024) and the 2025 International Conference on One-Carbon Metabolism, B-Vitamins and Homocysteine, the examination of the literature and the NICE/DELPHI guidelines allowed us to identify gaps and issues on diagnostic criteria and definition, evaluation of causation, and treatment strategies of vitamin B₁₂ deficiency across different health care settings in adults >18 y. Our perspective is to address these gaps and issues in global guidelines to be evaluated by the IUNS (International Union of Nutrition Societies). We identified 4 main goals: 1) definition of vitamin B₁₂ deficiency; 2) assessment of causality; 3) differential diagnosis and evaluation of nutritional and metabolic co-morbidities; and 4) treatment and follow-up. The objective of such guidelines should be to reduce both under- and over- diagnoses of vitamin B₁₂ deficiency by integrating clinical scoring, biomarker algorithms, and to consider cause-specific treatment pathways, This should ultimately improve patient outcomes worldwide and, by