Effect of calcium supplementation on reversing metformin-based inhibition of vitamin B 12 bioavailability in healthy adults using a [ 13 C] cyanocobalamin tracer - A pilot study.

Autor: Muralidharan J; Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India., Romould GG; Medical Student, St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India., Kashyap S; Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India., Pasanna R; Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India., Sivadas A; Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India., Sachdev HS; Department of Paediatrics, Sitaram Bhartia Institute of Science and Research, New Delhi, India., Kurpad AV; Department of Physiology, St. John's Medical College, St. John's National Academy of Health Sciences, Bangalore, India., Devi S; Division of Nutrition, St. John's Research Institute, St. John's National Academy of Health Sciences, Bangalore, India. Electronic address: sarita@sjri.res.in.
Jazyk: angličtina
Zdroj: Clinical nutrition ESPEN [Clin Nutr ESPEN] 2024 Aug; Vol. 62, pp. 76-80. Date of Electronic Publication: 2024 May 13.
DOI: 10.1016/j.clnesp.2024.04.024
Abstrakt: Background & Aims: Metformin is a widely prescribed first line drug for the treatment of type 2 diabetes mellitus (DM). Studies have shown that the use of metformin is often associated with a decrease in vitamin B 12 (B 12 ) levels in patients with DM. Few studies have shown that this effect could be mitigated with calcium supplementation. In the present study, we quantified the effect of metformin, and metformin co-administered with calcium on B 12 absorption using a novel stable isotope [ 13 C] cyanocobalamin tracer.
Methods: A pilot crossover study was conducted to estimate the bioavailability of B 12 in healthy subjects, using [ 13 C] cyanocobalamin as a tracer. In the study, [ 13 C] cyanocobalamin was administered orally to the participants followed by hourly venous sampling to measure the concentration of the tracer and estimate bioavailability. This protocol was followed for three experiment days, each separated by a one month wash out period. As part of the study, all participants received the tracer alone for the control day (C), metformin 850 mg along with the tracer for the metformin day (M) and metformin 850 mg with calcium 500 mg and the tracer for the metformin calcium day (MC).
Results: Seven participants completed all three experiment days. The mean B 12 bioavailability (±SD, n = 7) was 42.6 ± 10.2% for the control day (C), 30.8 ± 15.3% for the metformin day (M) and 46.4 ± 8.6% for the metformin-calcium day (MC). Repeated measures ANOVA was done and the pairwise comparison showed a significant difference in the B 12 bioavailability between control and metformin day (C vs M p = 0.010), and between the metformin and metformin with calcium day (M vs MC p = 0.003).
Conclusion: B 12 bioavailability reduced significantly from baseline (C) when metformin (M) was administered and this reduction was reversed when calcium was co-administered (MC) in healthy participants. In patients using metformin, calcium supplementation as a strategy to prevent B 12 deficiency needs to be further studied.
Competing Interests: Declaration of competing interest No potential conflicts of interests to declare.
(Copyright © 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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