Vitamin B12 Deficiency in the South of Jordan: A Possible Geographical Correlation Vitamin B12 in Jordan

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Mazhar Salim Al Zoubi


Cobalamin, Vitamin Deficiency, Geographical location, Vitamin B12


Vitamin B12 deficiency has been associated with certain serious disorders such as megaloblastic anemia as well as cardiovascular, neurological, and psychological disorders. Vitamin B12 deficiency is a worldwide health concern and a severe health problem in certain developing countries. In the current study, we aimed to evaluate the situation of vitamin B12 and estimate the prevalence of vitamin B12 deficiency in southern Jordan. The study population included 281 participants from Aqaba city: 71.2% females and 28.8% males with a mean age of 30.01±13.5. The results showed that the average vitamin B12 level was 277.34±103.70 pg/mL. The study population showed that 69 (24.6%) participants had a vitamin B12 deficiency. The current findings showed a lower frequency of vitamin B12 deficiency in the studied population compared to the rest of Jordan, especially in the north. The females reported a significantly higher frequency of vitamin B12 deficiency (29.0%) compared to the male group (13.6%). In addition, the CBC parameters showed a significant association between the level of vitamin B12 and Hb, RBC, PCV, and platelet count with a p-value = 0.044, <0.001, 0.021, 0.025, respectively. On the other hand, the results showed a lack of association between the vitamin B12 level and MCV and age group. In conclusion, the current study supports our previous findings regarding the correlation between geographical locations and the deficiency of vitamin B12. These findings can be attributed to the lifestyle and nutrient situation in Aqaba city which relies more on seafood. Moreover, other factors such as genetic predisposition can be excluded as an association factor. Therefore, more studies are required to evaluate vitamin B12 levels in Jordan at a higher scale that will include genetic analysis as well as food habits. 


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1. Fedosov SN. Physiological and molecular aspects of cobalamin transport. Water Soluble Vitamins: Springer; 2012. p. 347-67.
2. Gille D, Schmid A. Vitamin B12 in meat and dairy products. Nutrition reviews. 2015;73(2):106-15.
3. Herbert V. Vitamin B-12: plant sources, requirements, and assay. The American journal of clinical nutrition. 1988;48(3):852-8.
4. Watanabe F. Vitamin B12 sources and bioavailability. Experimental biology and medicine. 2007;232(10):1266-74.
5. Kalra S, Li N, Yammani RR, Seetharam S, Seetharam B. Cobalamin (vitamin B12) binding, phylogeny, and synteny of human transcobalamin. Archives of biochemistry and biophysics. 2004;431(2):189-96.
6. Wuerges J, Garau G, Geremia S, Fedosov SN, Petersen TE, Randaccio L. Structural basis for mammalian vitamin B12 transport by transcobalamin. Proceedings of the National Academy of Sciences. 2006;103(12):4386-91.
7. Moll R, Davis B. Iron, vitamin B12 and folate. Medicine. 2017;45(4):198-203.
8. O’Leary F, Samman SJN. Vitamin B12 in health and disease2010;2(3):299-316.
9. van der Linden IJ, Afman LA, Heil SG, Blom HJ. Genetic variation in genes of folate metabolism and neural-tube defect risk. Proceedings of the Nutrition Society. 2006;65(2):204-15.
10. Pitkin RM, Allen L, Bailey L, Bernfield M. Dietary Reference Intakes for Thiamin, riboflavin, niacin, vitamin B6, folate, vitamin B12, Pantothenic acid, biotin and choline. Washington, DC. 2000.
11. Gröber U, Kisters K, Schmidt JJN. Neuroenhancement with vitamin B12—underestimated neurological significance2013;5(12):5031-45.
12. Brito A, Habeych E, Silva-Zolezzi I, Galaffu N, Allen LHJNr. Methods to assess vitamin B12 bioavailability and technologies to enhance its absorption2018;76(10):778-92.
13. Antony AC. Vitamin B 12 (Cobalamin) and Folate Deficiency. Concise Guide to Hematology: Springer; 2019. p. 37-48.
14. Ankar A, Kumar A. Vitamin B12 Deficiency (Cobalamin). StatPearls [Internet]: StatPearls Publishing; 2019.
15. Sukumar N, Rafnsson SB, Kandala N-B, Bhopal R, Yajnik CS, Saravanan PJTAjocn. Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis2016;103(5):1232-51.
16. El-Khateeb M, Khader Y, Batieha A, Jaddou H, Hyassat D, Belbisi A, Ajlouni KJAoN, Metabolism. Vitamin B12 deficiency in Jordan: a population-based study2014;64(2):101-5.
17. Al Zoubi MS, Al-Batayneh KM, Al-Trad B, Haddad Y, Hussein E, Al Khateeb W, Aljabali AA, Bodoor K, Shehab M, Al Hamad M. Evaluation of Vitamin B12, Folate and Ferritin Serum Levels in Jordanian Population. Journal of nutritional science and vitaminology. 2019;65(4):309-17.
18. Al-Batayneh KM, Al Zoubi MS, Al-Trad B, Hussein E, Al Khateeb W, Aljabali AA, Bodoor K, Shehab M, Al Hamad MA, Eaton GJ. Homologous G776G Variant of Transcobalamin-II Gene is Linked to Vitamin B12 Deficiency. International Journal for Vitamin and Nutrition Research. 2019.
19. Al-Batayneh KM, Al Zoubi MS, Shehab M, Al-Trad B, Bodoor K, Al Khateeb W, Aljabali AA, Al Hamad M, Eaton G. Association between MTHFR 677C> T polymorphism and vitamin B12 deficiency: a case-control study. Journal of Medical Biochemistry. 2018;37(2):141-7.
20. Pupić-Bakrač A, Pervan A, Pupić-Bakrač J, Končurat JJMFMF. Extremely severe vitamin B12 deficiency–case presentation and review of literature2019;55(3):301-10.
21. Dror DK, Allen LH. Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutrition reviews. 2008;66(5):250-5.
22. Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency. Bmj. 2014;349.
23. Quinlivan E, McPartlin J, McNulty H, Ward M, Strain J, Weir D, Scott J. Importance of both folic acid and vitamin B12 in reduction of risk of vascular disease. The Lancet. 2002;359(9302):227-8.
24. Gröber U, Kisters K, Schmidt J. Neuroenhancement with vitamin B12—underestimated neurological significance. Nutrients. 2013;5(12):5031-45.
25. Gröber UJDM, Interactions D. Micronutrients: Metabolic tuning-prevention-therapy2009;24(2-4):331-.
26. Koury MJ, Ponka P. New insights into erythropoiesis: the roles of folate, vitamin B12, and iron. Annu Rev Nutr. 2004;24:105-31.
27. Bernard MA, Nakonezny PA, Kashner TM. The effect of vitamin B12 deficiency on older veterans and its relationship to health. Journal of the American Geriatrics Society. 1998;46(10):1199-206.
28. Eastley R, Wilcock GK, Bucks RS. Vitamin B12 deficiency in dementia and cognitive impairment: the effects of treatment on neuropsychological function. International Journal of Geriatric Psychiatry. 2000;15(3):226-33.
29. Obeid R, Geisel J, Schorr H, Hübner U, Herrmann W. The impact of vegetarianism on some haematological parameters. European Journal of Haematology. 2002;69(5‐6):275-9.
30. Miller JW, Garrod MG, Allen LH, Haan MN, Green R. Metabolic evidence of vitamin B-12 deficiency, including high homocysteine and methylmalonic acid and low holotranscobalamin, is more pronounced in older adults with elevated plasma folate. The American journal of clinical nutrition. 2009;90(6):1586-92.
31. Andrès E, Loukili NH, Noel E, Kaltenbach G, Abdelgheni MB, Perrin AE, Noblet-Dick M, Maloisel F, Schlienger J-L, Blicklé J-FJC. Vitamin B12 (cobalamin) deficiency in elderly patients2004;171(3):251-9.
32. Green R, Allen LH, Bjørke-Monsen A-L, Brito A, Guéant J-L, Miller JW, Molloy AM, Nexo E, Stabler S, Toh B-HJNrDp. Vitamin B 12 deficiency2017;3(1):1-20.
33. Pawlak R, Parrott SJ, Raj S, Cullum-Dugan D, Lucus D. How prevalent is vitamin B12 deficiency among vegetarians? Nutrition reviews. 2013;71(2):110-7.
34. Pawlak R, Lester S, Babatunde T. The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature. European journal of clinical nutrition. 2014;68(5):541-8.
35. Clarke R, Refsum H, Birks J, Evans JG, Johnston C, Sherliker P, Ueland PM, Schneede J, McPartlin J, Nexo EJTAjocn. Screening for vitamin B-12 and folate deficiency in older persons2003;77(5):1241-7.
36. Lee S, O’Dell D, Hohenstein J, Colt S, Mehta S, Erickson DJSr. NutriPhone: a mobile platform for low-cost point-of-care quantification of vitamin B 12 concentrations2016;6:28237.
37. Moll R, Davis BJM. Iron, vitamin B12 and folate2017;45(4):198-203.
38. Stabler SPJNEJoM. Vitamin B12 deficiency2013;368(2):149-60.
39. Hunt A, Harrington D, Robinson SJB. Vitamin B12 deficiency2014;349.
40. Bousselamti A, El Hasbaoui B, Echahdi H, Krouile YJTPAMJ. Psychomotor regression due to vitamin B12 deficiency2018;30.
41. Dror DK, Allen LHJNr. Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms2008;66(5):250-5.
42. Carmel RJArom. Current concepts in cobalamin deficiency2000;51(1):357-75.
43. Stabler SP, Allen RH. Vitamin B12 deficiency as a worldwide problem. Annu Rev Nutr. 2004;24:299-326.
44. Hin H, Clarke R, Sherliker P, Atoyebi W, Emmens K, Birks J, Schneede J, Ueland PM, Nexo E, Scott JJA, ageing. Clinical relevance of low serum vitamin B12 concentrations in older people: the Banbury B12 study2006;35(4):416-22.
45. Matthews JHJBsch. 12 Cobalamin and folate deficiency in the elderly1995;8(3):679-97.
46. McLean ED, Allen LH, Neumann CG, Peerson JM, Siekmann JH, Murphy SP, Bwibo NO, Demment MW. Low plasma vitamin B-12 in Kenyan school children is highly prevalent and improved by supplemental animal source foods. The Journal of nutrition. 2007;137(3):676-82.
47. Siekmann JH, Allen LH, Bwibo NO, Demment MW, Murphy SP, Neumann CG. Kenyan school children have multiple micronutrient deficiencies, but increased plasma vitamin B-12 is the only detectable micronutrient response to meat or milk supplementation. The Journal of nutrition. 2003;133(11):3972S-80S.
48. Taneja S, Bhandari N, Strand TA, Sommerfelt H, Refsum H, Ueland PM, Schneede J, Bahl R, Bhan MK. Cobalamin and folate status in infants and young children in a low-to-middle income community in India. The American journal of clinical nutrition. 2007;86(5):1302-9.
49. Refsum H, Yajnik CS, Gadkari M, Schneede J, Vollset SE, Örning L, Guttormsen AB, Joglekar A, Sayyad MG, Ulvik A. Hyperhomocysteinemia and elevated methylmalonic acid indicate a high prevalence of cobalamin deficiency in Asian Indians. The American journal of clinical nutrition. 2001;74(2):233-41.
50. Langan RC, Goodbred AJJAfp. Vitamin B12 deficiency: recognition and management2017;96(6):384-9.
51. Pfeiffer CM, Caudill SP, Gunter EW, Osterloh J, Sampson EJ. Biochemical indicators of B vitamin status in the US population after folic acid fortification: results from the National Health and Nutrition Examination Survey 1999–2000–. The American journal of clinical nutrition. 2005;82(2):442-50.
52. Pfeiffer CM, Johnson CL, Jain RB, Yetley EA, Picciano MF, Rader JI, Fisher KD, Mulinare J, Osterloh JD. Trends in blood folate and vitamin B-12 concentrations in the United States, 1988–2004. The American journal of clinical nutrition. 2007;86(3):718-27.
53. Campbell AK, Miller JW, Green R, Haan MN, Allen LH. Plasma vitamin B-12 concentrations in an elderly Latino population are predicted by serum gastrin concentrations and crystalline vitamin B-12 intake. The Journal of nutrition. 2003;133(9):2770-6.
54. Clarke R, Grimley Evans J, Schneede J, Nexo E, Bates C, Fletcher A, Prentice A, Johnston C, Ueland P, Refsum H. Vitamin B12 and folate deficiency in later life. Age and ageing. 2004;33(1):34-41.
55. Clarke R, Sherliker P, Hin H, Nexo E, Hvas AM, Schneede J, Birks J, Ueland PM, Emmens K, Scott JM. Detection of vitamin B12 deficiency in older people by measuring vitamin B12 or the active fraction of vitamin B12, holotranscobalamin. Clinical chemistry. 2007;53(5):963-70.
56. Allen LH. Folate and vitamin B 12 status in the Americas. Nutrition reviews. 2004;62(suppl_1):S29-S33.
57. Al Zoubi MS, Al-Batayneh KM, Al-Trad B, Haddad Y, Hussein E, Al Khateeb W, Aljabali AA, Bodoor K, Shehab M, Al Hamad MJJons, vitaminology. Evaluation of Vitamin B12, Folate and Ferritin Serum Levels in Jordanian Population2019;65(4):309-17.
58. Abu-Samak M, Khuzaie R, Abu-Hasheesh M, Jaradeh M, Fawzi MJJoAS. Relationship of vitamin B12 deficiency with overweight in male Jordanian youth2008;8(17):3060-3.
59. Barghouti F, Younes N, Halaseh L, Said T, Ghraiz SJE-EMHJ, 15 , 853-860,. High frequency of low serum levels of vitamin B [12] among patients attending Jordan University Hospital2009.
60. Alomari MA, Khabour OF, Gharaibeh MY, Qhatan RAJTP, sportsmedicine. Effect of physical activity on levels of homocysteine, folate, and vitamin B12 in the elderly2016;44(1):68-73.
61. Fora MA, Mohammad MAJSmj. High frequency of suboptimal serum vitamin B12 level in adults in Jordan2005;26(10):1591-5.
62. Hakooz N, Abu-Dahab R, Arafat T, Hamad M. A trend of low serum vitamin B12 in Jordanian adults from two ethnic groups in Amman. Jordanian Med J. 2006;40:80-7.
63. Qutob MS, Takruri HR, Barghouti FF. Evaluation of true vitamin B12 deficiency in a group of Jordanians aged 20-40 years visiting the Jordan University Hospital. Pakistan Journal of Nutrition. 2011.
64. Barghouti F, Younes N, Halaseh L, Said T, Ghraiz S. High frequency of low serum levels of vitamin B [12] among patients attending Jordan University Hospital. EMHJ-Eastern Mediterranean Health Journal, 15 (4), 853-860, 2009. 2009.
65. Perry M. Understanding vitamin B12 and folate deficiency. Practice Nursing. 2020;31(2):70-4.
66. Figlin E, Chetrit A, Shahar A, Shpilberg O, Zivelin A, Rosenberg N, Brok‐Simoni F, Gadoth N, Sela BA, Seligsohn U. High prevalences of vitamin B12 and folic acid deficiency in elderly subjects in Israel. British journal of haematology. 2003;123(4):696-701.
67. Loikas S, Koskinen P, Irjala K, Löppönen M, Isoaho R, Kivelä S-L, Pelliniemi T-T. Vitamin B12 deficiency in the aged: a population-based study. Age and ageing. 2007;36(2):177-83.
68. Allen LH. How common is vitamin B-12 deficiency? The American journal of clinical nutrition. 2009;89(2):693S-6S.
69. Aslinia F, Mazza JJ, Yale SH. Megaloblastic anemia and other causes of macrocytosis. Clinical medicine & research. 2006;4(3):236-41.
70. Veit K, editor. Pseudothrombotic microangiopathy and vitamin B12 deficiency in pernicious anemia. Baylor University Medical Center Proceedings; 2017: Taylor & Francis.
71. Prueksaritanond S, Barbaryan A, Mirrakhimov AE, Liana P, Ali AM, Gilman AD. A puzzle of hemolytic anemia, iron and vitamin B12 deficiencies in a 52-year-old male. Case reports in hematology. 2013;2013.
72. Sahin K, Elevli M, Coskun C. Frequency of Anemia and Correlation with Mean Erythrocyte Volume in Children with B12 and Folate Deficiency2019.
73. Oosterhuis W, Niessen R, Bossuyt P, Sanders G, Sturk A. Diagnostic value of the mean corpuscular volume in the detection of vitamin B12 deficiency. Scandinavian journal of clinical and laboratory investigation. 2000;60(1):9-18.
74. Vant Sant P, Küsters P, HARTHOORN‐LASTHUIZEN E. Dependency of MCV and haemoglobin concentration on plasma vitamin B12 levels in relation to sex and age. Clinical & Laboratory Haematology. 1997;19(1):23-5.
75. Sun A, Chang JYF, Wang YP, Cheng SJ, Chen HM, Chiang CP. Do all the patients with vitamin B12 deficiency have pernicious anemia? Journal of Oral Pathology & Medicine. 2016;45(1):23-7.
76. Toh B-H. Pathophysiology and laboratory diagnosis of pernicious anemia. Immunologic research. 2017;65(1):326-30.
77. Abdulmanea A, Alsaeed A, Shaik A, AlGahtani F. Prevalence of pernicious anemia in patients with macrocytic anemia and low serum B12. Pakistan Journal of Medical Sciences. 2014;30(6):1218.