Ethnic Disparities in Vitamin B12 and Folate Deficiency Prevalence and their Haematological Correlates in Malaysia.
DOI:
https://doi.org/10.70672/740haf92Keywords:
Vitamin B12, folate, deficiency, macrocytic anaemia, megaloblastic an, MalaysiaAbstract
Introduction: Vitamin B12 and folate deficiency are preventable conditions that can lead to serious haematological and neuropsychiatric complications if untreated. Global prevalence varies, and data from Malaysia is limited. This study aimed to determine the proportion and associated risk factors of these deficiencies in a Malaysian hospital population. Materials and methods: A cross-sectional, retrospective study was conducted using data from the Laboratory Information System of Hospital Teluk Intan from June 2023 to May 2024. Demographic data and serum B12/folate levels from 1,463 subjects were analyzed. Deficiency proportions were calculated, and associations with demographic factors and haematological profiles were examined using Chi-square and multinomial logistic regression. Results: The proportion of isolated vitamin B12, isolated folate, and combined deficiencies were 3.2%, 14.5% and 2.9% respectively. Indian ethnicity was significantly associated with higher odds of all deficiency types. Chinese ethnicity was associated with isolated B12 deficiency. Males and younger age groups (12-19 and 20-29 years) had significantly higher odds of isolated folate deficiency. A high proportion of macrocytic anaemia was observed in isolated B12 (52.17%) and combined deficiencies (64.28%), as was megaloblastic anaemia (56.52% and 61.90%, respectively). Conclusion: Significant racial, age, and gender disparities exist in the prevalence of B12 and folate deficiencies, which are strongly associated with haematological complications. These findings highlight the need for targeted screening and intervention strategies in high-risk groups within the Malaysian population.
References
[1]. Food And Agriculture Organization of the United Nations, World Health Organization. Vitamin and mineral requirements in human nutrition. Geneva: World Health Organization; 2005.
[2]. Abali EE, et al. Lippincott Illustrated Reviews: Biochemistry. Philadelphia: Wolters Kluwer; 2022.
[3]. World Health Organization. Vitamin mineral requirements in human nutrition. 2nd ed. Available from:[https://apps.who.int/iris/bitstream/handle/10665/42716/9241546123.pdf] (https://apps.who.int/iris/bitstream/handle/10665/42716/9241546123.pdf)
[4]. NIH Office of Dietary Supplements. Vitamin B12 [Internet]. no date. Available from: [https://ods.od.nih.gov/factsheets/VitaminB12HealthProfessional/](https://ods.od.nih.gov/fact sheets/VitaminB12-HealthProfessional/) Accessed 24 Oct 2024.
[5]. Branch N, Pirkle J, Director. Laboratory Procedure Manual Vitamin B12 (B12) Roche E‑170 Vitamin B12 ‘ECLIA’. Available from: [https://wwwn.cdc.gov/nchs/data/nhanes/public/2013/labmethods/VITB12_H_MET_VITA IMIN_B12.pdf](https://wwwn.cdc.gov/nchs/data/nhanes/public/2013/labmethods/VITB12_ H_MET_VITAIMIN_B12.pdf)
[6]. Carmel R, Tatsis B, Baril L. Circulating antibody to transcobalamin II causing retention of vitamin B12 in the blood. Blood. 1977;49(6):987–1000. doi:10.1182/blood.v49.6.987.bloodjournal496987
[7]. Zhou Y, et al. Folate and vitamin B12 usual intake and biomarker status by intake source in United States adults aged ≥19 y: NHANES 2007–2018. Am J Clin Nutr. 2023;118(1):241–
254. doi:10.1016/j.ajcnut.2023.05.016.
[8]. B12-Folate deficiency NICE. Available at: https://cks.nice.org.uk/topics/anaemia-b12- folate-deficiency/.
[9]. Hunt, A., Harrington, D. and Robinson, S. (2014) ‘Vitamin B12 Deficiency’, BMJ, 349. Available at: https://doi.org/10.1136/bmj.g5226.
[10]. Pawlak R, Lester SE, Babatunde T. The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: A review of literature. Eur J Clin Nutr. 2014;68:541–548.
[11]. Singla R, Garg A, Surana V, Aggarwal S, Gupta G, Singla S. Vitamin B12 deficiency is endemic in Indian population: a perspective from North India. Indian J Endocrinol Metab. 2019;23:211. doi:10.4103/ijem.IJEM_122_19
[12]. WHO, Serum and red blood cell folate concentrations for assessing folate status in populations, 2015. https://www.who.int/publications/i/item/WHO-NMHNHD- EPG-15.01
[13]. Jones, K.S. et al. (2023) ‘National Diet and Nutrition Survey data reveal a decline in folate status in the United Kingdom population between 2008 and 2019’, The American Journal of Clinical Nutrition, 118(6). Available at: https://doi.org/10.1016/j.ajcnut.2023.10.006
[14]. Gonzalez‑Velez M, et al. Racial/ethnic differences in patients with anemia and folate deficiency. Int J Lab Hematol. 2020;42(4):403–410. doi:10.1111/ijlh.13205
[15]. Khor GL, et al. Dietary and blood folate status of Malaysian women of childbearing age. PubMed. 2006;15(3):341–349.
[16]. Min Kyaw Htet et al. (2015) ‘Folate and vitamin B12status and dietary intake of anaemic adolescent schoolgirls in the delta region of Myanmar’, British journal of nutrition, 116(S1),
pp. S36–S41. Available at: https://doi.org/10.1017/s0007114515001609.
[17]. Mahajan S, Aundhakar S. A study of the prevalence of serum vitamin B12 and folic acid deficiency in Western Maharashtra. J Family Med Prim Care. 2015;4(1):64. doi:10.4103/2249- 4863.152255
[18. Sundarakumar JS, Shahul Hameed SK, Ravindranath V. Burden of Vitamin D, Vitamin B12 and Folic Acid Deficiencies in an Aging, Rural Indian Community. Front Public Health. 2021;9:707036. doi:10.3389/fpubh.2021.707036
[19]. Khanduri U, Sharma A. Megaloblastic anemia: Prevalence and causative factors. Natl Med J India. 2006;20(4):172–175. Available from: [https://www.researchgate.net/publication/5763853_Megaloblastic_anemia_Prevalence_an d_causative_factors](https://www.researchgate.net/publication/5763853_Megaloblastic_ane mia_Prevalence_and_causative_factors) Accessed 6 Nov 2024.
[20]. Khajuria A, Das R. Prevalence of megaloblastic anaemia and its causative factors in a tertiary care centre at Western India. Santosh Univ J Health Sci. 2022;8:141–144.
[21]. Panigrahi A, Sahoo P. Nutritional anemia and its epidemiological correlates among women of reproductive age in an urban slum of Bhubaneswar, Orissa. Indian J Public Health. 2011;55(4):317. doi:10.4103/0019-557X.92415
[22]. Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med. 2013;35(2):121–126. doi:10.4103/0253-7176.116232
[23].Caliper Project. Caliper database. Available from: [https://caliperproject.ca/caliper/database/](https://caliperproject.ca/caliper/database/)
[24]. İspir E, Serdar MA, Ozgurtas T, Gulbahar O, Akın KO, Yesildal F, et al. Comparison of four automated serum vitamin B12 assays. Clin Chem Lab Med. 2015;53:1205–1213.
[25]. Kristensen GB, Rustad P, Berg JP, Aakre KM. Analytical bias exceeding desirable quality goal in 4 out of 5 common immunoassays: results of a native single serum sample external quality assessment program for cobalamin, folate, ferritin, thyroid‑stimulating hormone, and free T4 analyses. Clin Chem. 2016;62:1255–1263.
[26]. Reinstatler L, Qi YP, Williamson RS, Garn JV, Oakley GP. Association of Biochemical B12 Deficiency With Metformin Therapy and Vitamin B12 Supplements: the National Health and Nutrition Examination Survey, 1999–2006. Diabetes Care. 2012;35(2):327–333. doi:10.2337/dc11-1582
[27]. Hao, L. et al. (2003) ‘Geographical, Seasonal and Gender Differences in Folate Status among Chinese Adults’, The Journal of Nutrition, 133(11), pp. 3630–3635. Available at: https://doi.org/10.1093/jn/133.11.3630.
[28]. Okumura, K. and Tsukamoto, H. (2011) ‘Folate in smokers’, Clinica Chimica Acta, 412(7-8), pp. 521–526. Available at: https://doi.org/10.1016/j.cca.2011.01.003.
[29]. Halsted, C.H. et al. (2002) ‘Metabolic Interactions of Alcohol and Folate’, The Journal of Nutrition, 132(8), pp. 2367S2372S. Available at: https://doi.org/10.1093/jn/132.8.2367s.
[30].Nath, S.D., Samer Koutoubi and Huffman, F.G. (2006) ‘Folate and vitamin B12 status of a multiethnic adult population.’, PubMed, 98(1), pp. 67–72.
[31]. Alaimo K, McDowell MA, Briefel RR, et al. Dietary intake of vitamins, minerals, and fiber of persons ages 2 months and over in the United States: Third National Health and Nutrition Examination Survey, Phase 1, 1988-1991. Adv Data. 1994;258:1-28.
[32]. Online Mendelian Inheritance in Man, OMIM®. Johns Hopkins University, Baltimore, MD. MIM Number: 236250:
12/11/2014: https://omim.org/entry/236250#genotypePhenotypeCorrelations
[33]. Tsang BL, Devine OJ, Cordero AM, et al. Assessing the association between the methylenetetrahydrofolate reductase (MTHFR) 677C>T polymorphism and blood folate concentrations: a systematic review and meta-analysis of trials and observational studies. Am J Clin Nutr. 2015;101(6):1286-1294.
[34]. Crider KS, Yang TP, Berry RJ, Bailey LB. Folate and DNA methylation: A review of molecular mechanisms and the evidence for folate's role. Adv Nutr. 2012;3(1):21-38
[35]. Ayub T, Fazal. Prevalence of Megaloblastic Anaemia in a Paediatric Unit [Preprint]. DOAJ
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Asian Journal of Medicine & Health Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Journal of Engineering Technology (JET) is an open-access journal that follows the Creative Commons Attribution-Non-commercial 4.0 International License (CC BY-NC 4.0)
