Intakes of Vitamin B-12 from Dairy Food, Meat, and Fish and Shellfish Are Independently and Positively Associated with Vitamin B-12 Biomarker Status in Pregnant Dutch Women

Karlijn F. M. Denissen, Sandra G. Heil, Simone J. P. M. Eussen, Jim P. J. Heeskens, Carel Thijs, Monique Mommers, Luc J. M. Smits, Martien C. J. M. van Dongen, Pieter C. Dagnelie*

*Corresponding author for this work

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Background: The effect of vitamin B-12 from different animal foods on vitamin B-12 biomarker status has not previously been evaluated in pregnant women.

Objective: We examined the association of vitamin B-12 intake from dairy, meat, fish (including shellfish), and eggs with circulating concentrations of vitamin B-12 biomarkers and with the presence of vitamin B-12 deficiency in 1266 pregnant women participating in the KOALA Birth Cohort Study.

Methods: Blood samples were collected in weeks 34-36 of pregnancy, and vitamin B-12 intake from foods and supplements was estimated with a semiquantitative food-frequency questionnaire (FFQ). Total vitamin B-12, holotranscobalamin (holoTC), and methylmalonic acid (MMA) were determined in plasma. Vitamin B-12 deficiency was defined as holoTC <35 pmol/L and MMA > 0.45 mu mol/L. Associations were evaluated with linear and logistic regression analyses, adjusting for potential confounders.

Results: Significant dose-response relations were observed between vitamin B-12 intake from dairy, meat, and fish and plasma vitamin B-12, holoTC, and MMA [P-trend for (shell) fish with MMA = 0.002; P-trend for dairy, meat, and fish with all other markers <0.001]. The OR (95% CI) of vitamin B-12 deficiency in the third compared with the first tertile of dairy-derived vitamin B-12 was 0.13 (0.04, 0.49), and the ORs for vitamin B-12 from meat and fish were 0.33 (0.11, 0.97) and 0.25 (0.08, 0.82), respectively. Egg-derived vitamin B-12 was only associated with holoTC. Additional analyses showed that self-defined vegetarians and FFQ-defined lacto-ovo-vegetarians had lower median total dietary vitamin B-12 intake and considerably worse vitamin B-12 biomarker status than omnivores and pescatarians.

Conclusions: In pregnant Dutch women, higher intakes of vitamin B-12 from dairy, meat, and fish were positively associated with vitamin B-12 status, suggesting that dairy, meat, and fish are good sources of bioactive vitamin B-12 in pregnancy. Nevertheless, for (lacto-) vegetarians, vitamin B-12 supplementation is recommended.

Original languageEnglish
Pages (from-to)131-138
Number of pages8
JournalJournal of Nutrition
Issue number1
Publication statusPublished - Jan 2019


  • vitamin B-12 intake
  • pregnancy
  • plasma vitamin B-12
  • methylmalonic acid
  • holotranscobalamin
  • animal foods
  • vegetarian

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