Metabolic Complications and Neurological Symptoms of Vitamin B 12
Deficiency in Infants of Vegetarian Mothers
Smolka V., Bekárek V., Hlídková E., Bučil J., Mayerová D., Škopková Z., Adam T., Hrubá E., Kožich V., Buriánková L., Šaligová J., Buncová M., Zeman J.
Dětská klinika LF UP a FN, Olomouc Laboratoř dědičných metabolických poruch OKBL LF UPa FN, Olomouc Radiologická klinika LF UP a FN, Olomouc Ústav dědičných poruch metabolizmu 1. LF UK, Praha Oddělení klinické biochemie Dětské nemocnice LF a FN, Košice Radioizotopové pracoviště IKEM, Praha |
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Summary:
Background. Serious hematological, metabolic and neurological complications owing to the nutritional deficiency
of vitamin B 12 may occur in infants of mothers on a strict vegetarian diet.
Methods and Results. The mother of the first child was a strict vegetarian. She had an elevated urinary
methylmalonic acid level and a low concentration of serum vitamin B 12 . Her 13-month-old daughter was exclusively
breast-fed until the age of 9 month and then she was fed only vegetables. Physical examination revealed psychomotoric
retardation, apathy, muscular hypotonia, abnormal movements and failure to thrive. Laboratory analysis showed
a megaloblastic anaemia, a low level of vitamin B 12 and methylmalonic aciduria. MRI of the brain revealed diffuse
frontotemporoparietal atrophy and retardation of meylination. After treatment with vitamin B 12 supplements,
abnormal movements disappeared and development improved, but a mild generalised hypotonia continued. A cranial
MRI 9 months after treatment still showed signs of retardation of myelination. The second patient, an 8 month-old
male, son of a strict vegetarian mother too, was referred for investigation of psychomotoric retardation, hypotonia,
dyskinesia, failure to thrive and microcephaly. He was breast-fed and from 6 month of age he had also received fruit
juices. Laboratory analysis revealed megaloblastic anaemia, high methylmalonic aciduria and homocystinuria. The
patient’s and his mother’s serum level of vitamin B 12 were low. After treatment with vitamin B 12 supplements,
biochemical and metabolic markers of disease were normal but there continued a generalised hypotonia, microcep-
haly and language delay.
Conclusion. Our observations emphasize the health complications of nutritional cobalamine deficiency and
a requirement of clinical, biochemical and metabolic monitoring in infants within strict vegetarian families.
Key words:
vegetarian diet, vitamin B 12 , methylmalonic aciduria, homocystinuria, microcephaly, psychomotoric
retardation.
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