Framingham 后代研究 (Framingham Offspring Study) 发现,高达 39% 的美国成年人有维生素 B12 缺乏的风险(定义为血清维生素 B12 水平<258 pmol/L [<350 pg/mL] )。[3]Tucker KL, Rich S, Rosenberg I, et al. Plasma vitamin B-12 concentrations relate to intake source in the Framingham Offspring study. Am J Clin Nutr. 2000 Feb;71(2):514-22.http://www.ajcn.org/cgi/content/full/71/2/514http://www.ncbi.nlm.nih.gov/pubmed/10648266?tool=bestpractice.com 患病率随年龄增长而上升,并且根据所研究的人群和所使用的诊断方法不同,高龄人群患病率范围为 5% 至 15%。[4]Pennypacker LC, Allen RH, Kelly JP, et al. High prevalence of cobalamin deficiency in elderly outpatients. J Am Geriatr Soc. 1992 Dec;40(12):1197-204.http://www.ncbi.nlm.nih.gov/pubmed/1447433?tool=bestpractice.com[5]Clarke R, Grimley Evans J, Schneede J, et al. Vitamin B12 and folate deficiency in later life. Age Ageing. 2004 Jan;33(1):34-41.http://ageing.oxfordjournals.org/cgi/reprint/33/1/34http://www.ncbi.nlm.nih.gov/pubmed/14695861?tool=bestpractice.com[6]Andres E, Loukili NH, Noel E, et al. Vitamin B12 (cobalamin) deficiency in elderly patients. CMAJ. 2004 Aug 3;171(3):251-9.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC490077/http://www.ncbi.nlm.nih.gov/pubmed/15289425?tool=bestpractice.com[7]Pfisterer KJ, Sharratt MT, Heckman GG, et al. Vitamin B12 status in older adults living in Ontario long-term care homes: prevalence and incidence of deficiency with supplementation as a protective factor. Appl Physiol Nutr Metab. 2016 Feb;41(2):219-22.http://www.ncbi.nlm.nih.gov/pubmed/26781161?tool=bestpractice.com
营养性维生素 B12 缺乏在美国较少见,但在不服用膳食补充剂的严格素食者和一般素食者中,发病率可能较高。维生素 B12 缺乏在全球范围内的患病率可能要高于美国的患病率,尤其是在发展中国家。多项研究在 25%~70% 的受试人群中发现血清维生素 B12 水平偏低(<148 pmol/L [<200 pg/mL])的证据。[8]Björkegren K, Svärdsudd K. Serum cobalamin, folate, methylmalonic acid and total homocysteine as vitamin B12 and folate tissue deficiency markers amongst elderly Swedes - a population-based study. J Intern Med. 2001 May;249(5):423-32.https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2001.00819.xhttp://www.ncbi.nlm.nih.gov/pubmed/11350566?tool=bestpractice.com[9]Yajnik CS, Deshpande SS, Lubree HG, et al. Vitamin B12 deficiency and hyperhomocysteinemia in rural and urban Indians. J Assoc Physicians India. 2006 Oct;54:775-82.http://www.ncbi.nlm.nih.gov/pubmed/17214273?tool=bestpractice.com[10]Fakhrzadeh H, Ghotbi S, Pourebrahim R, et al. Total plasma homocysteine, folate, and vitamin B12 status in healthy Iranian adults: the Tehran homocysteine survey (2003-2004)/a cross-sectional population based study. BMC Public Health. 2006 Feb 13;6:29.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1403764/http://www.ncbi.nlm.nih.gov/pubmed/16472406?tool=bestpractice.com[11]Loikas S, Koskinen P, Irjala K, et al. Vitamin B12 deficiency in the aged: a population-based study. Age Ageing. 2007 Mar;36(2):177-83.http://ageing.oxfordjournals.org/cgi/content/full/36/2/177http://www.ncbi.nlm.nih.gov/pubmed/17189285?tool=bestpractice.com 随着为病态肥胖症患者实施的外科胃旁路术数量不断增加,维生素 B12 缺乏在美国的发病率和患病率可能会提高。[12]Weng TC, Chang CH, Dong YH, et al. Anaemia and related nutrient deficiencies after Roux-en-Y gastric bypass surgery: a systematic review and meta-analysis. BMJ Open. 2015 Jul 16;5(7):e006964.http://bmjopen.bmj.com/content/5/7/e006964.longhttp://www.ncbi.nlm.nih.gov/pubmed/26185175?tool=bestpractice.com 一篇系统评价发现,维生素 B12 缺乏症在妊娠期间常见,维生素 B12 的水平从妊娠早期到妊娠晚期期间呈下降趋势。[13]Sukumar N, Rafnsson SB, Kandala NB, et al. Prevalence of vitamin B-12 insufficiency during pregnancy and its effect on offspring birth weight: a systematic review and meta-analysis. Am J Clin Nutr. 2016 May;103(5):1232-51.http://ajcn.nutrition.org/content/103/5/1232.longhttp://www.ncbi.nlm.nih.gov/pubmed/27076577?tool=bestpractice.com