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Nutrition315 papers

Vitamin B12 deficiency glossitis

Last edited: 4/13/2026

Overview

Vitamin B12 deficiency glossitis refers to the inflammation and atrophy of the tongue associated with insufficient vitamin B12 levels, leading to symptoms such as glossal atrophy, smooth tongue, and sometimes neurological manifestations. 41224

Diagnosis

  • Clinical Symptoms: Glossal atrophy, smooth tongue, and potential neurological symptoms like cognitive impairment, depression, and ataxia. 1224
  • Laboratory Tests: Measure serum vitamin B12 levels, methylmalonic acid (MMA), and homocysteine levels. Elevated MMA and homocysteine are sensitive markers of deficiency. 4112027
  • Holistic Assessment: Consider dietary history, particularly in vegetarians and vegans, and evaluate for underlying conditions like pernicious anemia. 222535

    • Management

  • First-Line Treatment: Oral high-dose vitamin B12 supplementation (e.g., 1 mg daily or weekly). 19293351
  • Alternative Routes: Intramuscular (IM) injections for rapid correction, especially in severe cases or poor oral absorption. 7153349
  • Sublingual and Other Forms: Sublingual methylcobalamin can be effective and well-tolerated, particularly in pediatric patients. 71529
  • Monitoring: Regular follow-up to assess normalization of vitamin B12 levels, MMA, and homocysteine, and clinical improvement. 193351

    • Special Populations

  • Pediatrics: Early diagnosis and treatment with oral or sublingual B12 are crucial to prevent developmental delays. 7122224
  • Elderly: Higher prevalence; consider routine screening, especially in those with folate levels above normal ranges, which may mask B12 deficiency. 4143548
  • Pregnancy: Maternal deficiency can lead to severe neonatal complications; supplementation is essential, particularly in vegetarian or vegan mothers. 2555

    • Key Recommendations

  • Screen for Vitamin B12 Deficiency in elderly and high-risk groups (vegetarians, vegans, those with gastrointestinal disorders) using serum B12, MMA, and homocysteine levels. (Evidence: Moderate 42027)
  • Initiate Oral High-Dose Supplementation for most cases of vitamin B12 deficiency, with consideration for IM injections in severe or rapidly progressing cases. (Evidence: Moderate 193351)
  • Monitor Response through biochemical markers and clinical symptoms to ensure adequate correction and prevent long-term complications. (Evidence: Moderate 193351)

    • References

    1 Reynolds EH, Sobczyńska-Malefora A, Green R. Fortification, folate and vitamin B12 balance, and the nervous system. Is folic acid excess potentially harmful?. European journal of clinical nutrition 2025. link 2 Fedosov SN, Nexo E, Heegaard CW. Kinetics of Cellular Cobalamin Uptake and Conversion: Comparison of Aquo/Hydroxocobalamin to Cyanocobalamin. Nutrients 2024. link 3 El Rhermoul FZ, Mustafa A, Wagner A, Nakonechna A, Kayode OS, Rutkowski R et al.. Vitamin B. The journal of allergy and clinical immunology. In practice 2024. link 4 Gyawali P, Bhatt RD, Karmacharya RM, Pant V, Khadka A. High Burden of Vitamin B12 Deficiency among Adults and Elderly. Journal of Nepal Health Research Council 2023. link 5 Demirtas MS, Erdal H. Evaluation of thiol disulfide balance in adolescents with vitamin B12 deficiency. Italian journal of pediatrics 2023. link 6 Karabayir N, Teber BG, Dursun HK, Pehlivan LS. Is There An Association Between Vitamin B12 Level and Vitamin D Status in Children?. Journal of pediatric hematology/oncology 2022. link 7 Orhan Kiliç B, Kiliç S, Şahin Eroğlu E, Gül E, Belen Apak FB. Sublingual methylcobalamin treatment is as effective as intramuscular and peroral cyanocobalamin in children age 0-3 years. Hematology (Amsterdam, Netherlands) 2021. link 8 Boran P, Baris HE, Kepenekli E, Erzik C, Soysal A, Dinh DM. The impact of vitamin B12 deficiency on infant gut microbiota. European journal of pediatrics 2020. link 9 Tuğba-Kartal A, Çağla-Mutlu Z. Comparison of Sublingual and Intramuscular Administration of Vitamin B12 for the Treatment of Vitamin B12 Deficiency in Children. Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion 2020. link 10 Ramalho MJ, Andrade S, Coelho MAN, Loureiro JA, Pereira MC. Molecular interactions between Vitamin B12 and membrane models: A biophysical study for new insights into the bioavailability of Vitamin. Colloids and surfaces. B, Biointerfaces 2020. link 11 Greibe E, Mahalle N, Bhide V, Fedosov S, Heegaard CW, Naik S et al.. Effect of 8-week oral supplementation with 3-µg cyano-B12 or hydroxo-B12 in a vitamin B12-deficient population. European journal of nutrition 2019. link 12 Serin HM, Arslan EA. Neurological symptoms of vitamin B12 deficiency: analysis of pediatric patients. Acta clinica Croatica 2019. link 13 Sun W, Li G, Lai Z, Lu Z, Lin Y, Peng J et al.. Subacute Combined Degeneration of the Spinal Cord and Hydrocephalus Associated with Vitamin B12 Deficiency. World neurosurgery 2019. link 14 Zant A, Awwad HM, Geisel J, Keller M, Obeid R. Vitamin B12-fortified toothpaste improves vitamin status in elderly people: a randomized, double-blind, placebo-controlled study. Aging clinical and experimental research 2019. link 15 Bensky MJ, Ayalon-Dangur I, Ayalon-Dangur R, Naamany E, Gafter-Gvili A, Koren G et al.. Comparison of sublingual vs. intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency. Drug delivery and translational research 2019. link 16 Ramöller IK, Tekko IA, McCarthy HO, Donnelly RF. Rapidly dissolving bilayer microneedle arrays - A minimally invasive transdermal drug delivery system for vitamin B12. International journal of pharmaceutics 2019. link 17 Allen LH, Miller JW, de Groot L, Rosenberg IH, Smith AD, Refsum H et al.. Biomarkers of Nutrition for Development (BOND): Vitamin B-12 Review. The Journal of nutrition 2018. link 18 Mohamad SA, Sarhan HA, Abdelkader H, Mansour HF. Vitamin B12-Loaded Buccoadhesive Films as a Noninvasive Supplement in Vitamin B12 Deficiency: In Vitro Evaluation and In Vivo Comparative Study With Intramuscular Injection. Journal of pharmaceutical sciences 2017. link 19 Metaxas C, Mathis D, Jeger C, Hersberger KE, Arnet I, Walter P. Early biomarker response and patient preferences to oral and intramuscular vitamin B12 substitution in primary care: a randomised parallel-group trial. Swiss medical weekly 2017. link 20 Brito A, Verdugo R, Hertrampf E, Miller JW, Green R, Fedosov SN et al.. Vitamin B-12 treatment of asymptomatic, deficient, elderly Chileans improves conductivity in myelinated peripheral nerves, but high serum folate impairs vitamin B-12 status response assessed by the combined indicator of vitamin B-12 status. The American journal of clinical nutrition 2016. link 21 Reynolds EH. What is the safe upper intake level of folic acid for the nervous system? Implications for folic acid fortification policies. European journal of clinical nutrition 2016. link 22 Merchant RE, Phillips TW, Udani J. Nutritional Supplementation with Chlorella pyrenoidosa Lowers Serum Methylmalonic Acid in Vegans and Vegetarians with a Suspected Vitamin B₁₂ Deficiency. Journal of medicinal food 2015. link 23 Roy B, Trivedi R, Garg RK, Gupta PK, Tyagi R, Gupta RK. Assessment of functional and structural damage in brain parenchyma in patients with vitamin B12 deficiency: A longitudinal perfusion and diffusion tensor imaging study. Magnetic resonance imaging 2015. link 24 Takeichi T, Hsu CK, Yang HS, Chen HY, Wong TW, Tsai WL et al.. Progressive hyperpigmentation in a Taiwanese child due to an inborn error of vitamin B12 metabolism (cblJ). The British journal of dermatology 2015. link 25 Christian AM, Krishnaveni GV, Kehoe SH, Veena SR, Khanum R, Marley-Zagar E et al.. Contribution of food sources to the vitamin B12 status of South Indian children from a birth cohort recruited in the city of Mysore. Public health nutrition 2015. link 26 Goraya JS, Kaur S, Mehra B. Neurology of Nutritional Vitamin B12 Deficiency in Infants: Case Series From India and Literature Review. Journal of child neurology 2015. link 27 Güney T, Alişik M, Akinci S, Neşelioğlu S, Dilek I, Erel O. Evaluation of oxidant and antioxidant status in patients with vitamin B12 deficiency. Turkish journal of medical sciences 2015. link 28 Keskin EY, Keskin M. Severe vitamin B₁₂ deficiency in a 15-year-old boy: presentation with haemolysis and pancytopenia. BMJ case reports 2015. link 29 Kräutler B. Antivitamins B12--A Structure- and Reactivity-Based Concept. Chemistry (Weinheim an der Bergstrasse, Germany) 2015. link 30 Yoganathan S, Thomas MM, Mathai S, Ghosh U. Neuroregression as an initial manifestation in a toddler with acquired pernicious anaemia. BMJ case reports 2015. link 31 Merrigan SD, Owen WE, Straseski JA. Performance characteristics of the ARCHITECT Active-B12 (Holotranscobalamin) assay. Clinical laboratory 2015. link 32 Kocaoglu C, Akin F, Caksen H, Böke SB, Arslan S, Aygün S. Cerebral atrophy in a vitamin B12-deficient infant of a vegetarian mother. Journal of health, population, and nutrition 2014. link 33 Mearns GJ, Koziol-McLain J, Obolonkin V, Rush EC. Preventing vitamin B12 deficiency in South Asian women of childbearing age: a randomised controlled trial comparing an oral vitamin B12 supplement with B12 dietary advice. European journal of clinical nutrition 2014. link 34 Rehman HU. Vitamin B12 deficiency causing night sweats. Scottish medical journal 2014. link 35 El-Khateeb M, Khader Y, Batieha A, Jaddou H, Hyassat D, Belbisi A et al.. Vitamin B12 deficiency in Jordan: a population-based study. Annals of nutrition & metabolism 2014. link 36 Chakrabarty B, Dubey R, Gulati S, Yoganathan S, Kumar A, Kumar A. Isolated cerebellar involvement in vitamin B12 deficiency: a case report. Journal of child neurology 2014. link 37 Qi YP, Do AN, Hamner HC, Pfeiffer CM, Berry RJ. The prevalence of low serum vitamin B-12 status in the absence of anemia or macrocytosis did not increase among older U.S. adults after mandatory folic acid fortification. The Journal of nutrition 2014. link 38 Houle SK, Kolber MR, Chuck AW. Should vitamin B12 tablets be included in more Canadian drug formularies? An economic model of the cost-saving potential from increased utilisation of oral versus intramuscular vitamin B12 maintenance therapy for Alberta seniors. BMJ open 2014. link 39 Sun HY, Lee JW, Park KS, Wi JY, Kang HS. Spine MR imaging features of subacute combined degeneration patients. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society 2014. link 40 Baumgartner MR. Vitamin-responsive disorders: cobalamin, folate, biotin, vitamins B1 and E. Handbook of clinical neurology 2013. link 41 Kibirige D, Wekesa C, Kaddu-Mukasa M, Waiswa M. Vitamin B12 deficiency presenting as an acute confusional state: a case report and review of literature. African health sciences 2013. link 42 Demir N, Koc A, Üstyol L, Peker E, Abuhandan M. Clinical and neurological findings of severe vitamin B12 deficiency in infancy and importance of early diagnosis and treatment. Journal of paediatrics and child health 2013. link 43 Masucci L, Goeree R. Vitamin B12 intramuscular injections versus oral supplements: a budget impact analysis. Ontario health technology assessment series 2013. link 44 Mutti E, Lildballe DL, Kristensen L, Birn H, Nexo E. Vitamin B₁₂ dependent changes in mouse spinal cord expression of vitamin B₁₂ related proteins and the epidermal growth factor system. Brain research 2013. link 45 Watt AM, Willis CD, Hodgetts K, Elshaug AG, Hiller JE. Engaging clinicians in evidence-based disinvestment: role and perceptions of evidence. International journal of technology assessment in health care 2012. link 46 Ganjehei L, Massumi A, Razavi M, Wilson JM. Orthostatic hypotension as a manifestation of vitamin B12 deficiency. Texas Heart Institute journal 2012. link 47 Guez S, Chiarelli G, Menni F, Salera S, Principi N, Esposito S. Severe vitamin B12 deficiency in an exclusively breastfed 5-month-old Italian infant born to a mother receiving multivitamin supplementation during pregnancy. BMC pediatrics 2012. link 48 Zanus C, Alberini E, Costa P, Colonna F, Zennaro F, Carrozzi M. Involuntary movements after correction of vitamin B12 deficiency: a video-case report. Epileptic disorders : international epilepsy journal with videotape 2012. link 49 Sanz-Cuesta T, González-Escobar P, Riesgo-Fuertes R, Garrido-Elustondo S, del Cura-González I, Martín-Fernández J et al.. Oral versus intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency: a pragmatic, randomised, multicentre, non-inferiority clinical trial undertaken in the primary healthcare setting (Project OB12). BMC public health 2012. link 50 Minnet C, Koc A, Aycicek A, Kocyigit A. Vitamin B12 treatment reduces mononuclear DNA damage. Pediatrics international : official journal of the Japan Pediatric Society 2011. link 51 Favrat B, Vaucher P, Herzig L, Burnand B, Ali G, Boulat O et al.. Oral vitamin B12 for patients suspected of subtle cobalamin deficiency: a multicentre pragmatic randomised controlled trial. BMC family practice 2011. link 52 Weber-Ferro W, Hertzberg C, Röder H, Timme K, Rossi R. Intact recovery from early 'acquired methylmalonic aciduria' secondary to maternal atrophic gastritis. Acta paediatrica (Oslo, Norway : 1992) 2011. link 53 Castelli MC, Friedman K, Sherry J, Brazzillo K, Genoble L, Bhargava P et al.. Comparing the efficacy and tolerability of a new daily oral vitamin B12 formulation and intermittent intramuscular vitamin B12 in normalizing low cobalamin levels: a randomized, open-label, parallel-group study. Clinical therapeutics 2011. link 54 Castelli MC, Wong DF, Friedman K, Riley MG. Pharmacokinetics of oral cyanocobalamin formulated with sodium N-[8-(2-hydroxybenzoyl)amino]caprylate (SNAC): an open-label, randomized, single-dose, parallel-group study in healthy male subjects. Clinical therapeutics 2011. link 55 Banka S, Roberts R, Plews D, Newman WG. Early diagnosis and treatment of cobalamin deficiency of infancy owing to occult maternal pernicious anemia. Journal of pediatric hematology/oncology 2010. link 56 Vanderbrink BA, Cain MP, King S, Meldrum K, Kaefer M, Misseri R et al.. Is oral vitamin B(12) therapy effective for vitamin B(12) deficiency in patients with prior ileocystoplasty?. The Journal of urology 2010. link 57 Deshmukh US, Joglekar CV, Lubree HG, Ramdas LV, Bhat DS, Naik SS et al.. Effect of physiological doses of oral vitamin B12 on plasma homocysteine: a randomized, placebo-controlled, double-blind trial in India. European journal of clinical nutrition 2010. link 58 . Oral or intramuscular vitamin B12?. Drug and therapeutics bulletin 2009. link 59 Dror DK, Allen LH. Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutrition reviews 2008. link 60 Dharmarajan TS, Kanagala MR, Murakonda P, Lebelt AS, Norkus EP. Do acid-lowering agents affect vitamin B12 status in older adults?. Journal of the American Medical Directors Association 2008. link 61 Cuskelly GJ, Mooney KM, Young IS. Folate and vitamin B12: friendly or enemy nutrients for the elderly. The Proceedings of the Nutrition Society 2007. link 62 Dogan EA, Yuruten B. Spinal myoclonus associated with vitamin B12 deficiency. Clinical neurology and neurosurgery 2007. link 63 Wyckoff KF, Ganji V. Proportion of individuals with low serum vitamin B-12 concentrations without macrocytosis is higher in the post folic acid fortification period than in the pre folic acid fortification period. The American journal of clinical nutrition 2007. link 64 Brocadello F, Levedianos G, Piccione F, Manara R, Pesenti FF. Irreversible subacute sclerotic combined degeneration of the spinal cord in a vegan subject. Nutrition (Burbank, Los Angeles County, Calif.) 2007. link 65 Koc A, Kocyigit A, Soran M, Demir N, Sevinc E, Erel O et al.. High frequency of maternal vitamin B12 deficiency as an important cause of infantile vitamin B12 deficiency in Sanliurfa province of Turkey. European journal of nutrition 2006. link 66 Nakao M, Kono N, Adachi S, Ebara S, Adachi T, Miura T et al.. Abnormal increase in the expression level of proliferating cell nuclear antigen (PCNA) in the liver and hepatic injury in rats with dietary cobalamin deficiency. Journal of nutritional science and vitaminology 2006. link 67 Mørkbak AL, Hvas AM, Lloyd-Wright Z, Sanders TA, Bleie O, Refsum H et al.. Effect of vitamin B12 treatment on haptocorrin. Clinical chemistry 2006. link 68 Butler CC, Vidal-Alaball J, Cannings-John R, McCaddon A, Hood K, Papaioannou A et al.. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials. Family practice 2006. link 69 Sethi NK, Mullin P, Torgovnick J, Capasso G. Nitrous oxide "whippit" abuse presenting with cobalamin responsive psychosis. Journal of medical toxicology : official journal of the American College of Medical Toxicology 2006. link 70 Park S, Johnson MA. What is an adequate dose of oral vitamin B12 in older people with poor vitamin B12 status?. Nutrition reviews 2006. link 71 Bor MV, Lydeking-Olsen E, Møller J, Nexø E. A daily intake of approximately 6 microg vitamin B-12 appears to saturate all the vitamin B-12-related variables in Danish postmenopausal women. The American journal of clinical nutrition 2006. link 72 Suzuki DM, Alagiakrishnan K, Masaki KH, Okada A, Carethers M. Patient acceptance of intranasal cobalamin gel for vitamin B12 replacement therapy. Hawaii medical journal 2006. link 73 Vidal-Alaball J, Butler CC, Cannings-John R, Goringe A, Hood K, McCaddon A et al.. Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. The Cochrane database of systematic reviews 2005. link 74 Dharmarajan TS, Adiga GU, Norkus EP. Vitamin B12 deficiency. Recognizing subtle symptoms in older adults. Geriatrics 2003. link 75 Ward PC. Modern approaches to the investigation of vitamin B12 deficiency. Clinics in laboratory medicine 2002. link00003-8) 76 Smith C. Selective cobalamin (vitamin B12) malabsorption in adolescence. A case report. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1988. link 77 Kafetz K. Immunoglobulin deficiency responding to vitamin B12 in two elderly patients with megaloblastic anaemia. Postgraduate medical journal 1985. link 78 Reynoso G, MacKenzie JR. Are ligand assay methods specific for cobalamin? A survey report. American journal of clinical pathology 1982. link 79 Thomas GE, Wicks AC, Clain DJ. Advantages of the plasma uptake method for measuring vitamin B12 absorption. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1977. link 80 Dastur DK, Santhadevi N, Quadros EV, Gagrat BM, Wadia NH, Desai MM et al.. Interrelationships between the B-vitamins in B12-deficiency neuromyelopathy. A possible malabsorption-malnutrition syndrome. The American journal of clinical nutrition 1975. link

    Original source

    1. [1]
      Fortification, folate and vitamin B12 balance, and the nervous system. Is folic acid excess potentially harmful? — Reynolds EH, Sobczyńska-Malefora A, Green R European journal of clinical nutrition (2025)
    2. [2]
      Kinetics of Cellular Cobalamin Uptake and Conversion: Comparison of Aquo/Hydroxocobalamin to Cyanocobalamin. — Fedosov SN, Nexo E, Heegaard CW Nutrients (2024)
    3. [3]
      Vitamin B — El Rhermoul FZ, Mustafa A, Wagner A, Nakonechna A, Kayode OS, Rutkowski R et al. The journal of allergy and clinical immunology. In practice (2024)
    4. [4]
      High Burden of Vitamin B12 Deficiency among Adults and Elderly. — Gyawali P, Bhatt RD, Karmacharya RM, Pant V, Khadka A Journal of Nepal Health Research Council (2023)
    5. [5]
      Evaluation of thiol disulfide balance in adolescents with vitamin B12 deficiency. — Demirtas MS, Erdal H Italian journal of pediatrics (2023)
    6. [6]
      Is There An Association Between Vitamin B12 Level and Vitamin D Status in Children? — Karabayir N, Teber BG, Dursun HK, Pehlivan LS Journal of pediatric hematology/oncology (2022)
    7. [7]
      Sublingual methylcobalamin treatment is as effective as intramuscular and peroral cyanocobalamin in children age 0-3 years. — Orhan Kiliç B, Kiliç S, Şahin Eroğlu E, Gül E, Belen Apak FB Hematology (Amsterdam, Netherlands) (2021)
    8. [8]
      The impact of vitamin B12 deficiency on infant gut microbiota. — Boran P, Baris HE, Kepenekli E, Erzik C, Soysal A, Dinh DM European journal of pediatrics (2020)
    9. [9]
      Comparison of Sublingual and Intramuscular Administration of Vitamin B12 for the Treatment of Vitamin B12 Deficiency in Children. — Tuğba-Kartal A, Çağla-Mutlu Z Revista de investigacion clinica; organo del Hospital de Enfermedades de la Nutricion (2020)
    10. [10]
      Molecular interactions between Vitamin B12 and membrane models: A biophysical study for new insights into the bioavailability of Vitamin. — Ramalho MJ, Andrade S, Coelho MAN, Loureiro JA, Pereira MC Colloids and surfaces. B, Biointerfaces (2020)
    11. [11]
      Effect of 8-week oral supplementation with 3-µg cyano-B12 or hydroxo-B12 in a vitamin B12-deficient population. — Greibe E, Mahalle N, Bhide V, Fedosov S, Heegaard CW, Naik S et al. European journal of nutrition (2019)
    12. [12]
      Neurological symptoms of vitamin B12 deficiency: analysis of pediatric patients. — Serin HM, Arslan EA Acta clinica Croatica (2019)
    13. [13]
      Subacute Combined Degeneration of the Spinal Cord and Hydrocephalus Associated with Vitamin B12 Deficiency. — Sun W, Li G, Lai Z, Lu Z, Lin Y, Peng J et al. World neurosurgery (2019)
    14. [14]
      Vitamin B12-fortified toothpaste improves vitamin status in elderly people: a randomized, double-blind, placebo-controlled study. — Zant A, Awwad HM, Geisel J, Keller M, Obeid R Aging clinical and experimental research (2019)
    15. [15]
      Comparison of sublingual vs. intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency. — Bensky MJ, Ayalon-Dangur I, Ayalon-Dangur R, Naamany E, Gafter-Gvili A, Koren G et al. Drug delivery and translational research (2019)
    16. [16]
      Rapidly dissolving bilayer microneedle arrays - A minimally invasive transdermal drug delivery system for vitamin B12. — Ramöller IK, Tekko IA, McCarthy HO, Donnelly RF International journal of pharmaceutics (2019)
    17. [17]
      Biomarkers of Nutrition for Development (BOND): Vitamin B-12 Review. — Allen LH, Miller JW, de Groot L, Rosenberg IH, Smith AD, Refsum H et al. The Journal of nutrition (2018)
    18. [18]
      Vitamin B12-Loaded Buccoadhesive Films as a Noninvasive Supplement in Vitamin B12 Deficiency: In Vitro Evaluation and In Vivo Comparative Study With Intramuscular Injection. — Mohamad SA, Sarhan HA, Abdelkader H, Mansour HF Journal of pharmaceutical sciences (2017)
    19. [19]
      Early biomarker response and patient preferences to oral and intramuscular vitamin B12 substitution in primary care: a randomised parallel-group trial. — Metaxas C, Mathis D, Jeger C, Hersberger KE, Arnet I, Walter P Swiss medical weekly (2017)
    20. [20]
      Vitamin B-12 treatment of asymptomatic, deficient, elderly Chileans improves conductivity in myelinated peripheral nerves, but high serum folate impairs vitamin B-12 status response assessed by the combined indicator of vitamin B-12 status. — Brito A, Verdugo R, Hertrampf E, Miller JW, Green R, Fedosov SN et al. The American journal of clinical nutrition (2016)
    21. [21]
      What is the safe upper intake level of folic acid for the nervous system? Implications for folic acid fortification policies. — Reynolds EH European journal of clinical nutrition (2016)
    22. [22]
      Nutritional Supplementation with Chlorella pyrenoidosa Lowers Serum Methylmalonic Acid in Vegans and Vegetarians with a Suspected Vitamin B₁₂ Deficiency. — Merchant RE, Phillips TW, Udani J Journal of medicinal food (2015)
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      Assessment of functional and structural damage in brain parenchyma in patients with vitamin B12 deficiency: A longitudinal perfusion and diffusion tensor imaging study. — Roy B, Trivedi R, Garg RK, Gupta PK, Tyagi R, Gupta RK Magnetic resonance imaging (2015)
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      Progressive hyperpigmentation in a Taiwanese child due to an inborn error of vitamin B12 metabolism (cblJ). — Takeichi T, Hsu CK, Yang HS, Chen HY, Wong TW, Tsai WL et al. The British journal of dermatology (2015)
    25. [25]
      Contribution of food sources to the vitamin B12 status of South Indian children from a birth cohort recruited in the city of Mysore. — Christian AM, Krishnaveni GV, Kehoe SH, Veena SR, Khanum R, Marley-Zagar E et al. Public health nutrition (2015)
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      Neurology of Nutritional Vitamin B12 Deficiency in Infants: Case Series From India and Literature Review. — Goraya JS, Kaur S, Mehra B Journal of child neurology (2015)
    27. [27]
      Evaluation of oxidant and antioxidant status in patients with vitamin B12 deficiency. — Güney T, Alişik M, Akinci S, Neşelioğlu S, Dilek I, Erel O Turkish journal of medical sciences (2015)
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      Severe vitamin B₁₂ deficiency in a 15-year-old boy: presentation with haemolysis and pancytopenia. — Keskin EY, Keskin M BMJ case reports (2015)
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      Neuroregression as an initial manifestation in a toddler with acquired pernicious anaemia. — Yoganathan S, Thomas MM, Mathai S, Ghosh U BMJ case reports (2015)
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      Performance characteristics of the ARCHITECT Active-B12 (Holotranscobalamin) assay. — Merrigan SD, Owen WE, Straseski JA Clinical laboratory (2015)
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      Cerebral atrophy in a vitamin B12-deficient infant of a vegetarian mother. — Kocaoglu C, Akin F, Caksen H, Böke SB, Arslan S, Aygün S Journal of health, population, and nutrition (2014)
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      Preventing vitamin B12 deficiency in South Asian women of childbearing age: a randomised controlled trial comparing an oral vitamin B12 supplement with B12 dietary advice. — Mearns GJ, Koziol-McLain J, Obolonkin V, Rush EC European journal of clinical nutrition (2014)
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      Severe vitamin B12 deficiency in an exclusively breastfed 5-month-old Italian infant born to a mother receiving multivitamin supplementation during pregnancy. — Guez S, Chiarelli G, Menni F, Salera S, Principi N, Esposito S BMC pediatrics (2012)
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