Low Serum Vitamin B12 is Significantly Associated with Depression: A Cross Sectional Observational Study 10.55131/jphd/2024/220221
Article Sidebar
Main Article Content
Abstract
Vitamin B12 plays a vital role in the prevention of psychological disorders. Studies have reported the positive impact of vitamin B12 supplementation on cognitive functions. However, epidemiological research on the prevalence of depression in the vitamin B12-deficient adult population is still insufficient. Thus, the present study investigates the prevalence of depression among the vitamin B12-deficient 400 adult participants, whose serum vitamin B12 status was below 200pg/mL, aged between 18 years to 60 years. The sociodemographic profile, anthropometric assessment and presence or absences of clinical symptoms were recorded via self-administered questionnaire. Participants were divided in Vitamin B12 insufficient and deficient group. Depression was screened by Beck- Depression Inventory II (BDI-II) scale, with 21-item self-administered survey. The study reported, 16% participants were from deficient group (serum vitamin B 12 below 150 pg/ml) with mean age 43.2±10.5 years. Depressive symptoms were found inversely associated with serum vitamin B12 levels. A significant association (at p<0.05) was found with age (chi sq=44.09, d.f.= 2, and p=0.001), gender (chi sq=7.91, d.f.= 1, and p=0.0048), body mass index (chi sq=12.97, d.f.= 2, and p=0.022), metformin usage (chi sq=8.31, d.f.= 2, and p=0.015), religion (chi sq=7.54, d.f.= 2, and p=0.022), income group (chi sq=5.71, d.f.= 2, and p=0.04), food preferences (chi sq=18.95, d.f.= 2, and p=0.00007) and clinical symptoms. The odds (CI) of depression among vitamin B12 deficient participants were found 5.88 (2.81-12.32), making it an independent predictor of depression. After adjusting with confounding variables, the association remained the same. The study revealed that the adult population with reduced vitamin B12 levels has higher probabilities of developing depression, and the chances increased with age. Thus, early detection and low cost supplementation should be implemented to combat vitamin B12 deficiency and its complications.
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
References
Yaman M, Çatak J, Uğur H, Gürbüz M, Belli İ, Tanyıldız SN, et al. The bioaccessibility of water-soluble vitamins: A review. Trends in Food Science & Technology. 2021;109:552-63. doi: https://doi.org/10.1016/ j.tifs.2021.01.056
Laird EJ, O'Halloran AM, Molloy AM, Healy M, Hernandez B, O'Connor DMA, et al. Low vitamin B(12) but not folate is associated with incident depressive symptoms in community-dwelling older adults: a 4-year longitudinal study. Br J Nutr. 2023;130(2):268-75. doi: 10.1017/ S0007114521004748.
Rizzo G, Laganà AS. A review of vitamin B12. Molecular Nutrition. 2020:105-29. doi: https://doi.org/10. 1016/B978-0-12-811907-5.00005-1
Mrozek W, Socha J, Sidorowicz K, Skrok A, Syrytczyk A, Piątkowska-Chmiel I, et al. Pathogenesis and treatment of depression: Role of diet in prevention and therapy. Nutrition. 2023;115:112143. doi: 10.1016/j.nut. 2023.112143.
Marx W, Penninx B, Solmi M, Furukawa TA, Firth J, Carvalho AF, et al. Major depressive disorder. Nat Rev Dis Primers. 2023;9(1):44. doi: 10.1038/s41572-023-00454-1.
Mohamed GG, Fekry AM, Attia FMA, Ibrahim NS, Azab SM. Simultaneous determination of some antidepressant drugs and vitamin B(12) in pharmaceutical products and urine sample using HPLC method. J Chromatogr B Analyt Technol Biomed Life Sci. 2020;1150:122178. doi: 10.1016/j.jchromb.2020.122178.
Dhiman P, Pillai RR, Wilson AB, Premkumar N, Bharadwaj B, Ranjan VP, et al. Cross-sectional association between vitamin B12 status and probable postpartum depression in Indian women. BMC Pregnancy Childbirth. 2021;21(1):146. doi: 10.1186/s12884-021-03622-x.
Trautmann C, Bock A, Urbach A, Hübner CA, Engmann O. Acute vitamin B12 supplementation evokes antidepressant response and alters Ntrk-2. Neuropharmacology. 2020; 171:108112. doi: 10.1016/ j.neuropharm.2020.108112.
Wolffenbuttel BHR, Wouters H, Heiner-Fokkema MR, van der Klauw MM. The Many Faces of Cobalamin (Vitamin B(12)) Deficiency. Mayo Clin Proc Innov Qual Outcomes. 2019;3(2):200-14. doi: 10.1016/ j.mayocpiqo.2019.03.002.
Azzini E, Raguzzini A, Polito A. A Brief Review on Vitamin B(12) Deficiency Looking at Some Case Study Reports in Adults. Int J Mol Sci. 2021;22(18). doi: 10.3390/ ijms22189694.
Nundy S, Kakar A, Bhutta ZA. How to calculate an adequate sample size? How to Practice Academic Medicine and Publish from Developing Countries? A Practical Guide. 2022:81-93.
Khairnar MR, Kumar PN, Kusumakar A. Updated BG prasad socioeconomic status classification for the year 2021. Journal of Indian Association of Public Health Dentistry. 2021;19(2):154-5. doi: 10.4103/jiaphd.jiaphd_52_21.
Weir CB, Jan A. BMI Classification Percentile And Cut Off Points. StatPearls. Treasure Island (FL): StatPearls Publishing 2024, StatPearls Publishing LLC.; 2024.
Beck AT, Steer RA, Brown G. Beck depression inventory–II. Psychological assessment. 1996. doi: https://doi.org/ 10.1037/t00742-000.
Williams ZJ, Everaert J, Gotham KO. Measuring Depression in Autistic Adults: Psychometric Validation of the Beck Depression Inventory-II. Assessment. 2021;28(3):858-76. doi: 10.1177/1073191120952889.
Esnafoglu E, Ozturan DD. The relationship of severity of depression with homocysteine, folate, vitamin B12, and vitamin D levels in children and adolescents. Child Adolesc Ment Health. 2020;25(4):249-55. doi: 10.1111/camh.12387.
Saraswathy KN, Ansari SN, Kaur G, Joshi PC, Chandel S. Association of vitamin B12 mediated hyperhomocysteinemia with depression and anxiety disorder: A cross-sectional study among Bhil indigenous population of India. Clinical nutrition ESPEN. 2019;30: 199-203. doi: https://doi.org/10.1016/ j.clnesp.2019.01.009
Markun S, Gravestock I, Jäger L, Rosemann T, Pichierri G, Burgstaller JM. Effects of Vitamin B12 Supplementation on Cognitive Function, Depressive Symptoms, and Fatigue: A Systematic Review, Meta-Analysis, and Meta-Regression. Nutrients. 2021;13(3). doi: 10.3390/ nu13030923
Wu Y, Zhang L, Li S, Zhang D. Associations of dietary vitamin B1, vitamin B2, vitamin B6, and vitamin B12 with the risk of depression: a systematic review and meta-analysis. Nutr Rev. 2022;80(3):351-66. doi: 10.1093/nutrit/nuab014.
Beulens JW, Sierksma A, Schaafsma G, Kok FJ, Struys EA, Jakobs C, et al. Kinetics of homocysteine metabolism after moderate alcohol consumption. Alcohol Clin Exp Res. 2005;29(5): 739-45. doi: 10.1097/01.alc.0000 163507.76773.1a.
Laufer EM, Hartman TJ, Baer DJ, Gunter EW, Dorgan JF, Campbell WS, et al. Effects of moderate alcohol consumption on folate and vitamin B(12) status in postmenopausal women. Eur J Clin Nutr. 2004;58(11): 1518-24. doi: 10.1038/sj.ejcn. 1602002.
Khairan P, Sobue T, Eshak ES, Zha L, Kitamura T, Sawada N, et al. Association of dietary intakes of vitamin B12, vitamin B6, folate, and methionine with the risk of esophageal cancer: the Japan Public Health Center-based (JPHC) prospective study. BMC Cancer. 2021;21(1):982. doi: 10.1186/s12885-021-08721-8.
Yang W, Cai X, Wu H, Ji L. Associations between metformin use and vitamin B(12) levels, anemia, and neuropathy in patients with diabetes: a meta-analysis. J Diabetes. 2019; 11(9): 729-43. doi: 10.1111/1753-0407. 12900.
Infante M, Leoni M, Caprio M, Fabbri A. Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind. World J Diabetes. 2021;12(7):916-31. doi: 10.4239/wjd.v12.i7.916.
Fituri S, Akbar Z, Ganji V. Impact of metformin treatment on cobalamin status in persons with type 2 diabetes. Nutr Rev. 2024;82(4):553-60. doi: 10.1093/nutrit/nuad045.
Yakubu M, Laing EF, Nsiah P, Anthony R, Acheampong E, Asamoah SK, et al. Vitamin B12 deficiency in type 2 diabetic patients on metformin: a cross-sectional study from South-Western part of Ghana. Alexandria Journal of Medicine. 2019;55(1):58-67. doi: https://doi.org/10.1080/ 20905068.2019.1662647
Marini CM, Ermer AE, Fiori KL, Rauer AJ, Proulx CM. Marital Quality, Loneliness, and Depressive Symptoms Later in Life: The Moderating Role of Own and Spousal Functional Limitations. Res Hum Dev. 2020; 17(4):211-34. doi: 10.1080/15427609. 2020.1837598.
Salinger JM, Whisman MA, Randall AK, Hilpert P. Associations Between Marital Discord and Depressive Symptoms: A Cross-Cultural Analysis. Fam Process. 2021;60(2): 493-506. doi: 10.1111/famp.12563.
Kim J, Ahn CW, Fang S, Lee HS, Park JS. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine (Baltimore). 2019;98(46):e17918. doi: 10.1097/MD.0000000000017918.
Almatrafi SB, Bakr ES, Almatrafi AA, Altayeb MM. Prevalence of vitamin B12 deficiency and its association with metformin-treated type 2 diabetic patients: A cross sectional study. Human Nutrition & Metabolism. 2022;27:200138. doi: https://doi.org/ 10.1016/j.hnm.2022.200138
Pratama S, Lauren BC, Wisnu W. The efficacy of vitamin B(12) supplementation for treating vitamin B(12) deficiency and peripheral neuropathy in metformin-treated type 2 diabetes mellitus patients: A systematic review. Diabetes Metab Syndr. 2022;16(10):102634. doi: 10.1016/j.dsx.2022.102634.
Sayedali E, Yalin AE, Yalin S. Association between metformin and vitamin B12 deficiency in patients with type 2 diabetes. World J Diabetes. 2023;14(5):585-93. doi: 10.4239/ wjd.v14.i5.585.
Kaviani M, Nikooyeh B, Zand H, Yaghmaei P, Neyestani TR. Effects of vitamin D supplementation on depression and some involved neurotransmitters. J Affect Disord. 2020;269:28-35. doi: 10.1016/j.jad. 2020.03.029.
Menon V, Kar SK, Suthar N, Nebhinani N. Vitamin D and Depression: A Critical Appraisal of the Evidence and Future Directions. Indian J Psychol Med. 2020;42(1):11-21. doi: 10.4103/IJPSYM.IJPSYM_1 60_19.