High Rates of B Vitamin Deficiency in Teens With Mental Illness

Liam Davenport

April 10, 2019

WARSAW, Poland — Levels of vitamin B9 and B12 deficiency are high in children and particularly adolescents with psychiatric disorders, say Spanish researchers. They suggested that such deficiencies may affect neurodevelopment and called for the problem to be addressed.

Gerard Anmella Diaz, MD, Department of Child and Adolescent Psychiatry, Hospital Clinic Barcelona, Spain, retrospectively evaluated almost 780 young people with psychiatric disorders who were treated in their unit during a 3-year period.

They found that overall, about 40% of patients were deficient in vitamin B9, and approximately 20% were deficient in vitamin B12. Just more than 10% were deficient in both vitamins.

Although there were generally no differences in vitamin deficiency between patients with and those without psychotic symptoms, patients with depressive symptoms were more likely than others to be deficient in vitamin B12.

The findings were presented here at the European Psychiatric Association (EPA) 2019 Congress.

Neglected Problem

Previous research published in Schizophrenia Bulletin and reported by Medscape Medical News shows a link between first-episode psychosis and low levels of folate and vitamin D.

Anmella Diaz told the conference delegates that his findings are "very important because they highlight a problem" that has been neglected in this patient population.

He underlined in particular the fact that the proportion of adolescents who are deficient in vitamin B9 and B12 is double that of children, noting that "the numbers need to change."

Anmella Diaz began by pointing out that both vitamin B9 and B12 are involved in glutathione and myelination pathways and that they have been shown to be involved in neuroplasticity and the preservation of neuronal integrity.

Deficiencies in these two vitamins lead to hyperhomocysteinemia, which has been linked to neurovascular and neurodegenerative disorders and psychiatric disorders, including schizophrenia and affective disorders, as well as cognitive impairment.

In the fetal and postnatal period, vitamin deficiencies are associated with demyelination and impairment of neurodevelopment, as well as the development of psychotic and affective disorders.

Anmella Diaz added that during childhood and adolescence, the brain undergoes synaptic pruning and reconstruction and the development of learning and memory circuits and executive functions, making it particularly vulnerable.

To determine levels of deficiency of vitamin B9 and B12, the investigators retrospectively examined the records of all child and adolescent psychiatric inpatients between 2015 and 2017 at their center.

The study included 779 individuals; the investigators gathered data on anthropometric variables, as well as clinical and blood test results.

Almost 40% of the sample were female, and the vast majority (87.5%) were adolescents at the time of admission. Overall, the mean age was 15.16 years; the age range was 7.11 to 17.99 years.

Vitamin B9 deficiency was detected in 42.4% of the patients, and 19.2% were deficient in vitamin B12; 11.0% were deficient in both vitamins.

Eating Disorder Finding Surprising

Female patients had significantly lower mean vitamin B9 levels than males, at 6.4 ng/mL vs 5.9 ng/mL (P = .038). There were no other significant sex-related differences.

Adolescents were substantially more likely than children to be deficient in vitamin B9, at 44.7% vs 26.1% (P = .001). The same pattern was found for vitamin B12, at 20.7% vs 9.7% (P = .012).

Average levels of vitamin B9 were significantly higher in children than adolescents, at 7.36 ng/mL vs 6.02 ng/mL (P = .001), as were levels of vitamin B12, at 500.4 pg/mL vs 420.5 pg/mL (P <.0001).

When the researchers examined individual psychiatric diagnoses, they were surprised to find there were no significant differences in the proportion of patients with vitamin B9 or B12 deficiency between those with and those without psychotic symptoms.

However, vitamin B12 levels were significantly lower in children and adolescents who had psychotic symptoms than in those without psychotic symptoms — 403.6 pg/mL vs 437.5 pg/mL (P = .022).

Patients with eating disorders were significantly less likely to be deficient in vitamin B9 than those without eating disorders, at 25.8% vs 45.7% (P < .0001).

They were also less likely than patients without eating disorders to be deficient in vitamin B12, at 8.6% vs 21.3% (P = .002).

Anmella Diaz said that the finding regarding patients with eating disorders was "a surprise" but suggested that it could be explained by the greater use of dietary supplements than in other patients "because of their follow-up in the psychiatry unit."

In general, the investigators found significant global differences between diagnostic groups in levels of vitamin B9 deficiency (P = .01) and mean vitamin B levels (P < .0001).

For vitamin B12 deficiency, the difference between diagnostic groups was less pronounced (P = .027). However, in patients with depression, levels of vitamin B12 deficiency tended to be higher than in other groups (P = .009).

There were also significant global differences in average vitamin B12 levels between diagnostic groups (P < .0001).

Need for Diagnosis, Supplementation

Commenting on the findings for Medscape Medical News, session chair Barbara Remberk, MD, PhD, from the Institute of Psychiatry and Neurology, Warsaw, Poland, said that vitamin deficiency in children and adolescents is "important."

She pointed out that the patients were not compared with the child and adolescent population who did not have psychiatric disorders.

"How many of them are deficient in the rest of the population?" she asked, noting that it would also be important to examine the sociodemographic characteristics of the young people included in the study.

Following the presentation, Remberk asked Anmella Diaz what he would recommend on the basis of these findings.

Anmella Diaz said the study initially assessed iron and vitamin D levels, as well as child-related parameters, and found deficits on all the measures they evaluated.

Vitamin deficiency, he said, "needs to be taken into account, and it needs to be supplemented. We've seen the correlation with psychiatric disorders and with neurodevelopmental impairment. It needs to be taken care of."

The investigators have disclosed no relevant financial relationships.

European Psychiatric Association (EPA) 2019 Congress: Abstract OC-0136. Presented April 9, 2019.

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