Relação entre níveis de vitamina B12 e resistência à insulina em mulheres na pós-menopausa da Colômbia Caribe
DOI:
https://doi.org/10.11606/issn.2176-7262.rmrp.2023.201354Palavras-chave:
Vitamina B12, Resistência à insulina, Dieta, Pós-Menopausa, Doenças cardiovascularesResumo
Introdução: A alta prevalência de baixos níveis séricos de vitamina B12 foi reconhecida como um problema de saúde pública na América Latina, mas a magnitude atual dessa deficiência na Colômbia é incerta. Baixos níveis de vitamina B12 podem induzir distúrbios hematológicos e neurológicos clínicos e subclínicos. Na verdade, estudos epidemiológicos demonstram uma relação entre deficiência de vitamina B12 e doenças cardiovasculares (DCVs). No entanto, o papel da vitamina B12 na resistência à insulina tem sido pouco estudado. Objetivo: O objetivo deste estudo foi avaliar a relação entre os níveis séricos de vitamina B12 e marcadores bioquímicos e antropométricos relacionados com doenças cardiovasculares e resistência à insulina em mulheres pós-menopáusicas da Colômbia Caribe. Métodos: Estudo correlacional, descritivo. Por amostragem de conveniência, foram vinculadas 182 mulheres na pós-menopausa do serviço de consulta médica de uma instituição de saúde. Níveis séricos de vitamina B12, variáveis antropométricas (índice de massa corporal, perímetro abdominal) e variáveis bioquímicas (glicemia, insulina, perfil lipídico, HOMA IR) foram avaliadas. Resultados: O valor médio do nível sérico de vitamina B12 foi de 312,5 ± 122,5 pg/mL (230,6 ± 90,4 pmol/L); 46,7% das mulheres tinham níveis abaixo do adequado de 300 pg/mL (> 221 pmol/L), e 9,9% eram deficientes, com níveis abaixo de 200 pg/mL (148 pmol/L). As mulheres com síndrome metabólica foram 63,7% e, segundo o HOMA IR, 52,7% apresentavam resistência à insulina. Uma relação inversa significativa entre os níveis séricos de vitamina B12 com glicemia basal (P = 0,002) e HOMA-IR (P = 0,040) foi mostrada. Conclusões: Foi observada uma relação inversa significativa entre os níveis de vitamina B12 e glicemia basal e HOMA-IR. Esses achados destacam a deficiência de vitamina B12 em mulheres na pós-menopausa e sugerem suplementação nutricional.
Downloads
Referências
Allen LH. Folate and vitamin B12status in theAmericas. Nutr Rev 2004; 62:29-33.11.
McLean E, de Benoist B, Allen LH. Review of themagnitude of folate and vitamin B12deficienciesworldwide. Food Nutr Bull 2008; 29:38-51.
Andrès E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ 2004; 171:251-9.
Marchi, G., Busti, F., Zidanes, A. L., Vianello, A., & Girelli, D. Cobalamin deficiency in the elderly. Mediterranean Journal of Hematology and Infectious Diseases. 2020;12(1):e2020043.
Lindenbaum J, Rosenberg IH, Wilson PW, Stabler SP, Allen RH. Prevalence of cobalamin deficiency in the Framingham elderly population. Am J Clin Nutr 1994; 60:2-11.
Van Asselt DZ, Blom HJ, Zuiderent R, Wevers RA, Jakobs C, van den Broek WJ, et al. Clinical significance of low cobalamin levels in older hospital patients. Neth J Med 2000; 57:41-9.
Guéant, J. L., Guéant-Rodriguez, R. M., Kosgei, V. J., & Coelho, D. Causes and consequences of impaired methionine synthase activity in acquired and inherited disorders of vitamin B12 metabolism. Critical reviews in biochemistry and molecular biology.2021;1-23.
Froese D. S, Fowler B, Baumgartner M. R. Vitamin B12, folate, and the methionine remethylation cycle—biochemistry, pathways, and regulation. J Inherit Metab Dis. 2019; 42:673–685.
Takahashi-Iñiguez T, García-Hernandez E, Arreguín-Espinosa R, Flores M. E. Role of vitamin B12 on methylmalonyl-CoA mutase activity. Zhejiang Univ. Sci. 2012; 13:423–437.
Selhub J. The many facets of hyperhomocysteinemia: studies from the Framingham cohort. J Nutr. 2006; 136:1726S–1730S.
Mahalle-Namita V, Kulkarni M.K, Garg-Sadanand S. N. Vitamin B12 deficiency and hyperhomocysteinemia as correlates of cardiovascular risk factors in Indian subjects with coronary artery disease. J. Cardiol. 2013; 61:289 – 294.
Jayashri R, Venkatesan U, Rohan M, et al. Prevalence of vitamin B12 deficiency in South Indians with different grades of glucose tolerance. Acta Diabetol. 2018; 55: 1283–1293.
Ko S. H, Kim H. S. Menopause-associated lipid metabolic disorders and foods beneficial for postmenopausal women. Nutrients. 2020;12(1), 202.
Spence JD. Increased coagulation with aging: importance of homocysteine and vitamin B12. Circ J. 2017;81(2):268.
Ministry of Health and Social Protection. Resolution number 2465 of 2016, anthropometric indicators, reference standards and cut-off points are adopted for the anthropometric classification of the nutritional status. Available online at: https://www.icbf.gov.co/sites/default/files/resolution_no._2465_del_14_de_june_de_2016.pdf.
Friedewald W.T, Levy R.I, Fredrickson D.S. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem. 1972; 18:499-502.
Matthews D.R, Hosker J.P, Rudenski A.S, Naylor B.A, Treacher D.F, Turner R.C. Homeostasis model assessment: insulin resistance and beta cell function from fasting plasma glucose and insulin concentrations in man. Diabetology.1985;28: 412-419.
Allen L. H, Miller J. W, De Groot L, Rosenberg I. H, Smith A. D, Refsum H, et al. Biomarkers of Nutrition for Development (BOND): Vitamin B-12 Review. J. Nutr 2018; 148:995S–2027S.
Aparicio-Ugarriza R, Palacios G., Alder M, et al. A review of the cut-off points for the diagnosis of vitamin B12 deficiency in the general population. Clin. Chem. Lab. Med 2014; 53:1149-1159.
Ankar A, Kumar A. Vitamin B12 deficiency. In StatPearls. Treasure Island: StatPearls Publishing; 2021.
Alberti KGMM, Eckel RH, Grundy SM, et al. Harmonizing the metabolic syndrome: A joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009;120:1640–1645.
Aguilar-Salinas C, Gómez-Pérez F, Lerman I. Diagnóstico y tratamiento de las dislipidemias: posición de la Sociedad Mexicana de Nutrición y Endocrinología. Rev Endocrinol Nutr. 2004; 12:7-4.
Gayoso-Diz P, Otero-Gonzalez A, Rodriguez-Alvarez MX, et al. Insulin resistance (HOMA-IR) cut-off values and the metabolic syndrome in a general adult population: effect of gender and age: EPIRCE cross-sectional study. Bmc Endocr Disord 2013; 13: 47.
Kouroglou, E., Anagnostis, P., Daponte, A., Bargiota A. Vitamin B12 insufficiency is associated with increased risk of gestational diabetes mellitus: a systematic review and meta-analysis. Endocrine. 2019;66(2):149-156.
Loikas S, Koskinen P, Irjala K, Lopponen M, Isoaho R, Kivela S.L, et al. Vitamin B12 Deficiency in the Aged: A Population-Based Study. Age and Ageing 2007; 36:177-183.
Stover PJ. Vitamin B12 and older adults. Curr Opin Clin Nutr Metab Care 2010; 13: 24-27.
Herrán O, Ward J, Villamor E. Vitamin B 12 serostatus in Colombian children and adult women: Results from a nationally representative survey. Public Health Nutr 2015; 18:836-843.
Ralapanawa D. M, Jayawickreme, K. P, Ekanayake E M, Jayalath W. A. B12 deficiency with neurological manifestations in the absence of anaemia. BMC research notes 2015; 8:458-467.
Pawlak R. Is Vitamin B12 Deficiency a Risk Factor for Cardiovascular Disease in Vegetarians? Am. J. Prev. Med. 2015;48:11-26.
Schaffer A, Verdoia M, Cassetti E, Marino P, Suryapranata H, Luca GD. Relationship between homocysteine and coronary artery disease. Results from a large prospective cohort study. Thromb Res. 2014; 134:288–93.
Ganguly P, Alam S. F. Role of homocysteine in the development of cardiovascular disease. Nutr. J. 2015;14: 1-10.
Li Z, Gueant-Rodriguez RM, Quilliot D, et al. Folate and vitamin B12 status is associated with insulin resistance and metabolic syndrome in morbid obesity. Clin Nutr. 2018; 37:1700‐1706.
Ho M, Halim J.H, Gow M.L, El-Haddad N.; Marzulli, T.; Baur, L.A.; Cowell, C.T.; Garnett, S.P. Vitamin B12 in Obese Adolescents with Clinical Features of Insulin Resistance. Nutrients. 2014; 6:5611-5618.
Kim J, Ahn CW, Fang S, Lee H. S, et al. Association between metformin dose and vitamin B12 deficiency in patients with type 2 diabetes. Medicine. 2019; 98(46).
Al-Hamdi A, Al-Gahhafi M, Al-Roshdi S, Jaju S, Al-Mamari A, Al Mahrezi AM. Vitamin B12 Deficiency in Diabetic Patients on Metformin Therapy: A cross-sectional study from Oman. Sultan Qaboos Univ Med J. 2020;20: e90‐e94.
Bauman WA, Shaw S, Jayatilleke E, Spungen AM, Herbert V. Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin. Diabetes Care 2000; 23:1227-1231.
Beulens JW, Hart HE, Kuijs R, Kooijman-Buiting AM, Rutten GE. Influence of duration and dose of metformin on cobalamin deficiency in type 2 diabetes patients using metformin. Acta Diabetol 2014; 52:47–53.
Willis CD, Metz MP, Hiller JE, Elshaug AG. Vitamin B12 and folate tests: The ongoing need to determine appropriate use and public funding. Med J Aust 2013; 198:586.
Jarquin C.A, Risch L, Nydegger U, Wiesner J, et al. Diagnostic accuracy of holotranscobalamin, vitamin B12, methylmalonic acid, and homocysteine in detecting B12 deficiency in a large, mixed patient population. Disease markers, 2020; 7468506: 1-11.
Downloads
Publicado
Edição
Seção
Licença
Copyright (c) 2023 Luz Adriana Sarmiento-Rubiano, Jimmy Everth Becerra, Roberto Carlos Rebolledo-Cobos, Norella Ortega-Ariza, María Cristina Sarmiento-Rubiano
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
