In India, most people adhere to a vegetarian diet, which may lead to cobalamin deficiency. About 75% of the subjects had metabolic signs of cobalamin deficiency, which was only partly explained by the vegetarian diet.
The study population included 204 men and women aged 27–55 y from Pune, Maharashtra, India, categorized into 4 groups:
- patients with cardiovascular disease (CVD) and diabetes,
- patients with CVD but no diabetes,
- patients with diabetes but no CVD,
- healthy subjects.
Data on medical history, lifestyle, and diet were obtained by interviews and questionnaires. Blood samples were collected for measurement of serum or plasma total cobalamin, holotranscobalamin (holoTC), methylmalonic acid (MMA), and total homocysteine (tHcy) and hemetologic indexes.
- Methylmalonic acid, total homocysteine, total cobalamin, and holotranscobalamin did not differ significantly among the 4 groups.
- Total cobalamin showed a strong inverse correlation with total homocysteine (r = −0.59) and methylmalonic acid (r = −0.54).
- 47% of the subjects had cobalamin deficiency (total cobalamin <150 pmol/L),
- 73% had low holotranscobalamin (<35 pmol/L),
- 77% had hyperhomocysteinemia (total homocysteine >15 μmol/L),
- 73% had elevated serum methylmalonic acid (>0.26 μmol/L).
These indicators of impaired cobalamin status were observed in both vegetarians and nonvegetarians.