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Ethnicity influences total serum vitamin B12 concentration: a study of Black, Asian and White patients in a primary care setting
  1. Jessica O'Logbon1,
  2. Martin Crook2,3,4,
  3. David Steed5,
  4. Dominic Jon Harrington6,7,
  5. Agata Sobczyńska-Malefora6,7
  1. 1GKT School of Medicine, King's College London Faculty of Life Sciences and Medicine, London, UK
  2. 2Clinical Biochemistry and Metabolic Medicine, Guy's, St Thomas' Trust, London, UK
  3. 3Clinical Biochemistry and Metabolic Medicine, Lewisham and Greenwich Trust, London, UK
  4. 4Hon Professor in Biochemical Medicine, King's College London, London, UK
  5. 5Viapath Informatics, Viapath, Francis House, St Thomas' Hospital, London, UK
  6. 6Faculty of Life Sciences and Medicine, King's College London, London, UK
  7. 7The Nutristasis Unit, Viapath, St. Thomas' Hospital, London, UK
  1. Correspondence to Jessica O'Logbon, GKT School of Medicine, King's College London Faculty of Life Sciences and Medicine, London SE1 1UL, UK; jessica.o'logbon{at}kcl.ac.uk

Abstract

Aims A growing body of evidence suggests that ethnicity and race influence vitamin B12 metabolism and status yet clinical awareness of this is poor, causing doubts regarding diagnosis and treatment. Moreover, deficiency and insufficiency cut-offs are universally applied for this test in most diagnostic settings. The objective of this study was to assess serum vitamin B12 concentrations in Black, Asian and White primary care patients in London, UK, particularly in patients of Black or Black British ethnic origin and establish if there is a need for specific reference ranges.

Methods Serum B12 results from 49 414 patients were processed between January 2018 and November 2019 using the Architect assay (Abbott Diagnostics) at St. Thomas’ Hospital, London, UK. Age, sex and ethnicity data were collected from the laboratory Health Informatics Team.

Results Black patients (n=13 806) were found to have significantly higher serum vitamin B12 concentration across all age groups and both sexes, especially Nigerian patients (median B12 505 pmol/L,IQR: 362–727, n=891), compared with Asian and White ethnic groups (p<0.001). Binary logistic regression analysis revealed that the Black or Black British ethnic group had the strongest association with elevated serum B12 (>652 pmol/L) (adjusted OR 3.38, 95% CI 3.17 to 3.61, p<0.0001).

Conclusions It is likely that a combination of genetic and acquired/environmental factors are responsible for the ethnic differences in serum B12. This suggests that there is a need for ethnic-specific reference ranges with indications for the incorporation of age and sex too.

  • vitamin B 12
  • vitamin B 12 deficiency
  • metabolism
  • medical laboratory science

Data availability statement

Data are available on reasonable request. This data are not in a repository. These data include deidentified diagnostic results (audit data) available from Agata Sobczyńska-Malefora at Viapath, London (https://orcid.org/0000-0001-7349-9517). Reuse is not permitted.

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Data availability statement

Data are available on reasonable request. This data are not in a repository. These data include deidentified diagnostic results (audit data) available from Agata Sobczyńska-Malefora at Viapath, London (https://orcid.org/0000-0001-7349-9517). Reuse is not permitted.

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Footnotes

  • Handling editor Mary Frances McMullin.

  • Twitter @DrDJHarrington

  • Contributors JO performed the statistical data analyses, designed the figures and drafted the manuscript, JO and AS-M interpreted the results. AS-M and MC designed the study. DS acquired data. JO, MC, DS, DJH and AS-M edited the manuscript. AS-M supervised the work and edited the final manuscript. All authors approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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