Overweight and obese adolescents: A risk group for vitamin B12 deficiency and anemia?



Vitamin B12, Obesity, Adolescent, Anemia, Ferritin


Background/Aim: Obesity is a major clinical and public health problem for adolescents. It leads to various nutritional problems as well as adult diseases such as cancer, cardiovascular diseases, and diabetes. Some studies have found that dietary intakes of some micronutrients were inadequate among adolescents. The aim of this study was to investigate anemia and vitamin B12 deficiency in obese children and adolescents and to determine whether obesity has a role in vitamin B12 deficiency. Additionally, we aimed to assess ferritin levels and their relationship with body mass index in obese children and adolescents. Methods: This retrospective cross-sectional study group consisted of 1574 patients between 10 and 18 years old who were admitted to the pediatrics department of the hospital, some for a weight problem and some, who constitute a control group, for other issues. Those excluded included patients with missing data, those with co-morbidities situations, patients taking vitamin supplements, children whose obesity was the result of a syndromic condition, and those whose obesity had endocrinal causes. Finally, 436 patients remained in the study. Vitamin B12 deficiency was defined as a serum level <200 ng/L. We defined anemia as a hemoglobin concentration under 12.5g/dl in males or 12g/dl in females according to depleted iron store, which is defined as a plasma ferritin level <12ug/L. Results: 252 (57.8%) of 436 patients were normal weight, 51 (11.7%) were overweight, and 133 (30.5%) were obese. The overweight/obesity group had a significantly higher level of plasma ferritin compared to the normal group. No relationship was found between weight and anemia (P=0.95). Vitamin B12 levels negatively correlated with increasing age (P<0.001, Spearman’s rho = -0,185). Obese and overweight adolescents had lower vitamin B12 concentrations than normal weight adolescents (P=0.01). Conclusion: Serum ferritin concentrations are higher in obese and overweight adolescents than in those with normal weight. Obese and overweight adolescents are at high risk for low serum vitamin B12 concentrations, but not for anemia.


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Pinhas-Hamiel O, Newfield RS, Koren I, Agmon A, Lilos P, Phillip M. Greater prevalence of iron deficiency in overweight and obese children and adolescents. International journal of obesity. 2003;27:416-8. doi: 10.1038/sj.ijo.0802224.

Pan America Health Organization (2010). Anemia among adolescent and young adult women in Latin America and the Caribbean: a cause for concern. Regional office of the World Health Organization https://www.paho.org/hq/dmdocuments/2010/AnemiaEngWEB.pdf

Pinhas-Hamiel O, Doron-Panush N, Reichman B, Nitzan-Kaluski D, Shalitin S, Geva-Lerner L. Obese children and adolescents: a risk group for low vitamin B12 concentration. Arch Pediatr Adolesc Med. 2006;160:933-6. doi: 10.1001/archpedi.160.9.933.

Ganji V, Hampl JS, Betts NM. Race- gender and age specific differences in dietary micronutrient intakes of US children. Int J Food Sci Nutr. 2003;54:485-90. doi: 10.1080/09637480310001622341.

Munoz KA, Krebs-Smith SM, Ballard- Barbash R, Cleveland LE. Food intakes of US children and adolescents compared with recommendations. Pediatrics. 1997;100:323-9. doi: 10.1542/peds.100.3.323.

Sharif MR, Madani M, Tabatabaie F. Comparative evaluation of iron deficiency among obese and non-obese children. Iranian Journal of Pediatric Hematology Oncology. 2014;4(4):160–6. PMID: 25598956.

Nead KG, Halterman JS, Kaczorowski JM, Auinger P, Weitzman M. Overweight children and adolescents: a risk group for iron deficiency. Pediatrics. 2004;114:104-8. doi: 10.1542/peds.114.1.104.

Huang YF, Tok TS, Lu CL, Ko HC, Chen MY, Chen SCC. Relationship between being overweight and iron deficiency in adolescents. Pediatrics and Neonatology. 2015;56:386-92, doi: 10.1016/j.pedneo.2015.02.003.

Ho M, Halim JH, Gow ML, El-Haddad N, Marzulli T, Baur LA, et al. Vitamin B12 in obese adolescents with clinical features of insülin resistance. Nutrients. 2014;6:5611-8. doi: 10.3390/nu6125611.

Stabler SP. Vitamin B12 deficiency. New England Journal of Medicine. 2013;368:149-160. doi: 10.1056/NEJMcp1113996.

Gunanti IR, Marks GC, Al-Mamun A, Long KZ. Low serum vitamin B12 and folate concentrations and low thiamin and riboflavin intakes are inversely associated with greater adiposity in Mexican American children. The journal of nutritional epidemiology. 2014;144(12):2027-33. doi: 10.3945/jn.114.201202.

Bundak R, Furman A, Gunoz H, Darendeliler F, Bas F, Neyzi O. Body mass index references for Turkish children. Acta Paediatr. 2006 Feb;95(2):194-8. doi: 10.1080/08035250500334738.

Lanzkowsky, Philip. Manual of Pediatric Hematology and Oncology. London: Elsevier, 2011, 80-86.

Kleigman, R.M, Stanton, B.F, St Geme, J.W, Schor N.F, Nelson Textbook of pediatrics. Behrman R.E (Ed), Philadelphia: Elsevier, 2016, 3465.

Lanzkowsky, Philip. Manual of Pediatric Hematology and Oncology. London: Elsevier, 2011, 38-57.

Ocak S, Kılıçaslan O, Yıldırmak ZY, Urgancı N. Adolesanlar ve anemi. Şişli Etfal Hastanesi Tıp Bülteni. 2017;51(4)309-17. doi: 10.5350/SEMB.20170927094446.

Looker AC, Dallman PR, Carroll MD, Gunter EW, Johnson CL. Prevalance of iron deficiency in the United States. JAMA. 1997;277:973-6. doi: 10.1001/jama.1997.03540360041028.

Shaw NS. Iron deficiency and anemia in school children and adolescents. J. Formos Med Assoc. 196;95:692-8. PMID: 8918058.

Mengistu G, Azage M, Gutema H. Iron deficiency anemia among in-school adolescent girls in rural area of Bahir Dar City Administration, North West Ethiopia. Hindawi Anemia. 2019. doi: 10.1155/2019/1097547

Moayeri H, Bidad K, Zadhous S, Gholami N, Anari S. Increasing prevalence of iron deficiency in overweight and obese children and adolescents. Eur J Pediatr. 2006;165:813-4. doi: 10.1007/s00431-006-0178-0.

Scheer JC, Guthrie HA. Hemoglobin criteria with respect to obesity. Am. J. Clin. Nutr. 1981;34:2748-2751. doi: 10.1093/ajcn/34.12.2748.

Şimşek CEÇ, Çelik N, Aygüneş U, Dönmez AY, Avcı E, Ekici M. Evaluation of hematological parameters and iron level in obese children and adolescents. Ankara Med J. 2019;(3):479-87. doi: 10.17098/amj.624400.

Zhu Y, He B, Xiao Y, Chen Y. Iron metabolism and its association with dyslipidemia risk in children and adolescents: a cross-sectional study. Lipids in health and disease. 2019;18:50. doi: 10.1186/s12944-019-0985-8.

Manios Y, Moschonis G, Chrousos GP, Lionis C, Mougios V, Kantilafti M. The double burden of obesity and iron deficiency on children and adolescents in Greece: the healthy growth study. J. Hum. Nutr. Diet. 2013;26(5):470-8. doi: 10.1111/jhn.12025.

Azab S, Saleh SH, Elsaeed FW, Elshafie MA, Sherief LM, Esh AMH. Serum trace elements in obese Egyptian Children: a case-control study. Italian Journal of Pediatrics. 2014;40:20. doi: 10.1186/1824-7288-40-20.

Ghadiri-Anari A, Nazemian N, Vahedian-Ardakani HA. Association of body mass index with hemoglobin concentration and iron parameters in Iranian population. ISRN Hematol. 2014;2014:525312. doi: 10.1155/2014/525312.

Seyrek B, Örnek Z, Battal F. The impact of childhood obesity on iron deficiency and its relationship with hepcidin, leptin, interleukin-6. İzmir Dr. Behçet Uz Çocuk Hastalıkları Dergisi. 2016;6(3):179-84. doi: 10.5222/buchd.2016.179.

MacFarlane AJ, Greene-Finestone LS, Shi Y. Vitamin B12 and homocysteine status in a folate-replete population: Results from the Canadian health measures survey. Am. J Clin Nutr. 2011;94(4):1079-87. doi: 10.3945/ajcn.111.020230.

Tungtrongchitr R, Pongpaew P, Tongboonchoo C, Vulhivai N, Changbumrung S, Tungtrongchitr A, et al. Serum homocysteine, B12 and folic acid concentration in Thai overweight and obese subjects. Int J Vitam Nutr Res. 2003;73:8-14. doi: 10.1024/0300-9831.73.1.8.

Rasmussen S, Fernhoff P, Scanlon KS. Vitamin B12 deficiency in children and adolescents. J Pediatr. 2001;138:10-7. doi: 10.1067/mpd.2001.112160






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Sevim M, Abseyi SN. Overweight and obese adolescents: A risk group for vitamin B12 deficiency and anemia?. J Surg Med [Internet]. 2022 Mar. 1 [cited 2023 Apr. 1];6(3):391-4. Available from: https://jsurgmed.com/article/view/898510