Patients with Liver cirrhosis suffer from functional cobalamin deficiency despite sufficient cobalamin serum levels

Introduction Liver cirrhosis is a complex disease associated with an increased risk of malnutrition, particularly vitamins and minerals. Interestingly in contrast to these findings, cirrhosis patients often exhibit normal or even elevated serum levels of vitamin B12. However, the extent to which a functional cobalamin deficiency exists despite adequate cobalamin plasma levels in these individuals has not yet been sufficiently investigated. Therefore, the aim of the present study was to determine functional cobalamin markers in serum of cirrhosis patients.

Methods Fifty-four patients with liver cirrhosis (Child-Pugh-Score: A:(n=1), B:(n=26), C:(n=27); male:(n=43), female:(n=11), etiology: alcohol:(n=49), others:(n=5) and a control group of 31 subjects without cirrhosis (male:(n=11), female:(n=22)) were included. We determined the most important cobalamin associated metabolic markers in all participants such as serum levels of vitamin B12, holo-transcobalamin, methylmalonic acid (MMA), folic acid, vitamin B6 and homocysteine.

Results Compared to controls (Ctrl), patients with cirrhosis (LC) exhibited significantly higher levels of vitamin B12 (642pmol/l vs. 298pmol/l) and holo-transcobalamin (159pmol/l vs. 98pmol/l). Interestingly, the serum MMA levels in LC were significantly higher than in Ctrl (256nmol/l vs. 183nmol/l). Conversely, homocysteine levels (18µmol/l vs. 22µmol/l) were lower in LC compared to Ctrl (p<0.05). All other markers did not differ between groups.

Conclusion The results suggest the presence of a functional cobalamin deficiency in liver cirrhosis patients despite normal B12 serum levels. On the other hand, the sole determination of B12 serum levels appears to be inadequate. Therefore, future clinical practice should include the assessment of additional functional markers such as MMA.

Publication History

Article published online:
23 January 2024