Evaluation of vitamin b12 and folic acid profiles in children with vasovagal syncope
Keywords:
children, vasovagal syncope, vitamin B12, folic acidAbstract
Sympathetic nervous system dysfunction is one of the main causes of vasovagal syncope development. The results of previous studies confirm the relationship between vitamin B12 levels and autonomic dysfunction, as well as the positive effect of vitamin B12 supplements on improving hemodynamic and autonomic functions in this group of patients.The aim was to study serum levels of vitamin B12 and folic acid in children with vasovagal syncope.
Materials and methods. The main group consisted of 30 children aged 8–17 years with a diagnosis of vasovagal syncope. 23 healthy children of the same age were included in the control group. The determination of serum vitamin B12 and folic acid was performed by a colorimetric enzyme-linked immunosorbent assay using the Monobind test system (USA). Vitamin B12 deficiency was diagnosed if its serum concentration was <300 pg/ml, folic acid deficiency was diagnosed if serum concentration was <3 ng/ml.
Results. The level of vitamin B12 in patients with vasovagal syncope was 308.73±18.31 pg/ml, and was significantly lower compared to the control group (447.28±22.70 pg/ml; p=0.000007). Folic acid in the serum of children did not differ significantly (3.87±0.25 ng/ml; 4.71±0.37 ng/ml; p=0.12). No reliable correlation was found between serum levels of vitamin B12 and folic acid in children with vasovagal syncope and the main clinical laboratory parameters of the disease (p>0.05). The prevalence of vitamin B12 deficiency in the vasovagal syncope group was 55.2% (p=0.0000), whereas folic acid deficiency was recorded in 30.4% of patients (p=0.06).
Conclusions. Compared with healthy children, patients with vasovagal syncope show a significant decrease in serum B12, while the folic acid profile remains unchanged. The prevalence of vitamin B12 deficiency in children with vasovagal syncope is 55.2%.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of an institution. The informed consent of the patient was obtained for conducting the studies.
No conflict of interest was declared by the author.
References
Azevedo FR, Brito BC. (2012). Influence of nutritional variables and obesity on health and metabolism. Rev Assoc Med Bras. 58: 714–23.
Brignole M, Moya A, Lange FJ et al. (2018). ESC Guidelines for the diagnosis and management of syncope. European Heart Journal. 39(21): 1883–1948. https://doi.org/10.1093/eurheartj/ehy210; PMid:29860370
Devalia V, Hamilton MS, Molloy AM. (2014, Aug). Guidelines for the diagnosis and treatment of cobalamin and folate disorders. British Journal of Haematology. 166(4): 496–513. https://doi.org/10.1111/bjh.12959; PMid:24942828
Finkelstein JL, Layden AJ, Stover PJ. (2015). Vitamin B12 and perinatal health. Adv Nutr. 6: 552–63. https://doi.org/10.3945/an.115.008201; PMid:26374177 PMCid:PMC4561829
Ghaznain M, Donnelly TM, Halpenny L. (2017). 019 Tilt Table Test Outcome in the Diagnosis and Prevalence of Syncope in Patients with Vitamin D and Vitamin B12 Deficiency. Age and Ageing. 46(3): 13–59. https://doi.org/10.1093/ageing/afx144.60
Gulacti U, Lok U, Hatipoglu S et al. (2014). Assessment of vitamin B12 and folic acid deficiency in emergency department as a cause of acute presentation of dizziness. Acta Medica Mediterranea. 30: 771–774.
Kanjwal K, Karabin B, Kanjwal Y, Grubb BP. (2010). Autonomic dysfunction presenting as postural orthostatic tachycardia syndrome in patients with multiple sclerosis. Int J Med Sci. 7: 62–7. https://doi.org/10.7150/ijms.7.62; PMid:20309394 PMCid:PMC2840604
Kula S, Olgunturk R, Tunaoglu FS, Saygili A. (2005). Distribution of syncopal episodes in children and adolescents with neurally mediated cardiac syncope through the day. Europace. 7: 634–7. https://doi.org/10.1016/j.eupc.2005.06.010; PMid:16216769
McDowell MA, Lacher DA, Pfeiffer CM et al. (2008). Blood folate levels: the latest NHANES results. NCHS Data Brief. (6): 1–8.
Olgunturk R, Turan L, Tunaoglu FS et al. (2003). Abnormality of the left ventricular sympathetic nervous function assessed by I123 metaiodobenzylguanidine imaging in pediatric patients with neurocardiogenic syncope. Pacing Clin Electrophysiol. 26: 1926–30. https://doi.org/10.1046/j.1460-9592.2003.00297.x; PMid:14516330
Oner T, Guven B, Tavli V et al. (2014). Postural Orthostatic Tachycardia Syndrome (POTS) and Vitamin B12 Deficiency in Adolescents. Pediatrics. 133(1): 138–142. https://doi.org/10.1542/peds.2012-3427; PMid:24366986
Parekh S, Sastry BKS, Narasimhan C, Arora H. (2018). To Study Vitamin B12 Deficiency and Response to Treatment in Patients Presenting With Vasovagal Syncope. J Cardiol. 2(5): 000134.
Pawlak R, Parrott SJ, Raj S et al. (2013). How prevalent is vitamin B12 deficiency among vegetarians? Nutr Rev. 71: 110–7. https://doi.org/10.1111/nure.12001; PMid:23356638
Pektas A, Koken R, Koca HB. (2018). Serum vitamin B012 in children presenting with vasovagal syncope. Asia Pacific Journal of Clinical Nutrition. 27: 176–181.
Serin HM, Arslan EA. (2019). Neurological symptoms of vitamin B12 deficiency: analysis of pediatric patients. Acta Clin Croat. 58(2): 295–302.
Shen W0K, Sheldon RS, Benditt DG et al. (2017). 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients with Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 136(5): e25–e59. https://doi.org/10.1161/CIR.0000000000000538
Tanaka H, Fujita Y, Takenaka Y et al. (2009). Japanese clinical guidelines for juvenile orthostatic dysregulation version 1.Pediatr Int. 51: 169–179. https://doi.org/10.1111/j.1442-200X.2008.02783.x; PMid:19371306
Theisen0Toupal J, Horowitz GL, Breu AC. (2013). Utility, charge, and cost of inpatient and emergency department serum folate testing. J. Hosp. Med. 2013;2: 91–95. https://doi.org/10.1002/jhm.1994; PMid:23169580
Zou R, Wang S, Zhu L et al. (2017). Calgary score and modified Calgary score in the differential diagnosis between neurally mediated syncope and epilepsy in children. Neurol Sci. 38(1): 143–149. https://doi.org/10.1007/s10072-016-2740-5; PMid:27747448
Downloads
Issue
Section
License
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.