■在1940年代至1950年代,临床上使用大剂量叶酸补充剂(>5mg/d)来逆转恶性贫血引起的维生素B12缺乏的巨幼细胞性贫血。然而,这种治疗策略掩盖了潜在的B12缺乏,并可能加剧其神经病理进展.最近,叶酸强化制度和广泛使用叶酸补充剂重新引发了掩盖和加剧B12缺乏症的问题。
■本综述的目的是描述临床和流行病学证据,表明过量叶酸会加剧B12缺乏症,为了总结一个解释这种现象的假设,并为临床医生提供指导。
■与低B12和未升高叶酸的人相比,低B12和高叶酸的人认知功能测试得分较低,血液同型半胱氨酸和甲基丙二酸浓度较高。恶性贫血或癫痫患者的高剂量叶酸补充导致血清B12显著降低。假设高剂量叶酸补充剂会导致血清全反式balamin消耗,从而加剧B12缺乏症。
■过量叶酸加重B12缺乏的证据主要是相关的或来自不受控制的临床观察,而解释这一现象的假设尚未得到检验。尽管如此,证据足够令人信服,需要提高警惕,以确定处于危险中的个体缺乏B12,包括老年人和其他低B12摄入量或与B12吸收不良相关的疾病,他们也摄入过量的叶酸或服用高剂量的叶酸。
简单的语言标题过量叶酸和维生素B12缺乏:临床意义?简单的语言摘要几十年来,人们已经知道高剂量的B族维生素补充剂,叶酸,可以缓解维生素B12缺乏的贫血,至少是暂时的。然而,通过缓解贫血,据说这种叶酸补充剂可以“掩盖”潜在的维生素B12缺乏症,从而允许神经损伤继续或可能加剧。因此,高剂量叶酸治疗维生素B12缺乏症在20世纪70年代停止.20世纪90年代,叶酸补充剂是否会加剧维生素B12缺乏症的问题再次出现,美国和加拿大(现在已经在全球80多个国家)对谷物和谷物进行叶酸强化,以防止脊柱裂和其他出生缺陷。这篇叙述性综述总结了评估患者和人群中叶酸和叶酸与维生素B12状态之间关系的研究结果。总结了最近关于叶酸如何加剧维生素B12缺乏的假设,并建议临床医生在评估某些维生素B12缺乏风险人群的维生素B12状况时提高警惕,包括老年人,患有胃肠道问题和其他导致维生素B12吸收不良的因素的人,患有无法解释的神经问题的人,以及遵循天然维生素B12低的素食或素食的人。
UNASSIGNED: In the 1940s to 1950s, high-dose folic acid supplements (>5 mg/d) were used clinically to reverse the megaloblastic anemia of vitamin B12 deficiency caused by pernicious anemia. However, this treatment strategy masked the underlying B12 deficiency and possibly exacerbated its neuropathological progression. The issue of masking and exacerbating B12 deficiency has recently been rekindled with the institution of folic acid fortification and the wide-spread use of folic acid supplements.
UNASSIGNED: The objectives of this review are to describe clinical and epidemiological evidence that excess folic acid exacerbates B12 deficiency, to summarize a hypothesis to explain this phenomenon, and to provide guidance for clinicians.
UNASSIGNED: Cognitive function test scores are lower and blood homocysteine and methylmalonic acid concentrations are higher in people with low B12 and elevated folate than in those with low B12 and nonelevated folate. High-dose folic acid supplementation in patients with pernicious anemia or epilepsy cause significant reductions in serum B12. It is hypothesized that high-dose folic acid supplements cause depletion of serum holotranscobalamin and thus exacerbate B12 deficiency.
UNASSIGNED: The evidence for excess folic acid exacerbating B12 deficiency is primarily correlative or from uncontrolled clinical observations, and the hypothesis to explain the phenomenon has not yet been tested. Nonetheless, the evidence is sufficiently compelling to warrant increased vigilance for identifying B12 deficiency in at risk individuals, including older adults and others with low B12 intake or conditions that are associated with B12 malabsorption, who also ingest excessive folic acid or are prescribed folic acid in high doses.
Plain language titleExcess Folic Acid and Vitamin B12 Deficiency: Clinical Implications?Plain language summaryIt has been known for many decades that high doses of the B vitamin supplement, folic acid, can alleviate the anemia of vitamin B12 deficiency, at least temporarily. However, by alleviating the anemia, such folic acid supplements were said to “mask” the underlying vitamin B12 deficiency, thus allowing neurological damage to continue or possibly be exacerbated. Consequently, treating vitamin B12 deficiency with high dose folic acid was discontinued in the 1970s. The issue of whether folic acid supplements can exacerbate vitamin B12 deficiency reemerged in the 1990s with folic acid fortification of cereals and grains in the United States and Canada (and now in over 80 countries around the world) to prevent spina bifida and other birth defects. This narrative review summarizes the results of studies that have assessed the relationships between folic acid and folate and vitamin B12 status in patients and in populations. A recent hypothesis on how folic acid might exacerbate vitamin B12 deficiency is summarized, and recommendations to clinicians are made for increased vigilance in assessing vitamin B12 status in certain groups at risk of vitamin B12 deficiency, including older adults, people with gastrointestinal issues and other factors that cause vitamin B12 malabsorption, people with unexplained neurological problems, and people who follow vegan or vegetarian diets which are naturally low in vitamin B12.