Status vitamina b12 i razvoj dece

Abstract

Uvod: Vitamin B12 ili kobalamin je hidrosolubilni vitamin koji učestvuje u stvaranju kateholamina, dezoksiribonukleinske kiseline, mijelina i u hematopoezi.

On je esencijalan faktor u intrauterinom razvoju mozga i mijelinizaciji sve do puberteta, pa i kasnije. Ljudski organizam nema sposobnost sinteze kobalamina, pa je zavistan od unosa ishranom ili supstitucijom. Cilj: Pregled savremene literature o deficijenciji vitamina B12 kod dece i adolescenata, prikaz tipične kliničke slike i diskusija terapijskih pristupa. Metode: Pretraga elektronskih baza podataka u sklopu servisa Konzorcijuma biblioteka Srbije za objedinjenu nabavku (KOBSON) sa ključnim rečima: vitamin

B12, kobalamin, deficijencija, deca, adolescenti. Rezultati: Deficit vitamina B12 je čest među decom i omladinom u zemlјama

u razvoju, ali sve češće i u razvijenim zemljama. Kod dece postoje tri osnovna uzroka deficijencije: 1. smanjen unos, 2. poremećaj resorpcije,

3. urođeni poremećaji transporta i metabolizma. Snižen nivo vitamina B12 u krvi povezan je sa negativnim ishodom trudnoće po majku i dete, podižući rizik za razvojne anomalije, spontani pobačaj, preeklampsiju i nisku težinu deteta na rođenju. Neuropsihološke posledice kod dece su kognitivni poremećaji

(smetnje pažnje, pamćenja i sniženje akademskog postignuća), izmene afekta

i ponašanja. Nekoliko kohortnih studija pokazalo je povezanost nivoa vitamina

B12 u krvi ili zastupljenost u ishrani majke sa kognitivnim ishodima kod dece. Međutim, najveći broj do sada objavljenih studija o negativnom uticaju sniženog nivoa vitamina B12 na kognitivni status dece je opservacionog tipa, te ne mogu potvrditi kauzalnu povezanost. Dijagnoza deficita vitamina B12 zasniva se na kliničkoj slici, neurološkom i psihijatrijskom nalazu, ispitivanju kognicije i laboratorijskoj dijagnostici, koja obuhvata cirkulatorne i funkcionalne biomarkere. Nadoknada deficita kobalamina je podjednako efikasna i

parenteralno i oralno, ukoliko se daju adekvatne doze. Zaključak: Nedostatak vitamina B12 je relativno čest među decom i omladinom i dovodi do neuroloških i psihijatrijskih smetnji koje, ako se ne leče, mogu

dovesti do ireverzibilnih promena.

Introduction: Vitamin B12, also known as cobalamin, is a water- soluble vitamin that participates in the synthesis of catecholamines, deoxyribonucleic acid, myelin, and hematopoiesis. It is an essential factor in the intrauterine development of the brain and myelination, extending through puberty, and later on in life. The human body lacks the ability to synthesize cobalamin, thus depending on dietary intake or supplementation. Aim: Review of current literature on vitamin B12 deficiency in children and adolescents, typical presentation and therapeutic approach. Methods: Literature search via electronic database within the Serbian Library Consortium for Coordinated Acquisition (KOBSON) with keywords: vitamin B12, cobalamin, deficiency, children, adolescents. Results: Vitamin B12 deficiency is common among children and adolescents in developing countries, but it is becoming increasingly prevalent in developed countries as well. In children, there are three main causes of deficiency: 1. Reduced intake, 2. Impaired absorption, 3. Inherited transport and metabolism disorders. Decreased levels of vitamin B12 in the blood are associated with adverse outcomes for both the mother and child during pregnancy, increasing the risk of developmental abnormalities, spontaneous abortion, preeclampsia, and low birth weight. Neuropsychological consequences in children include cognitive disorders (attention deficits, memory impairments, and decreased academic achievement), changes in mood, and behavior. Several cohort studies have shown an association between vitamin B12 levels in the blood or maternal dietary intake and cognitive outcomes in children. However, the majority of published studies on the negative impact of low vitamin B12 levels on the cognitive status of children are observational in nature and cannot confirm a causal relationship. The diagnosis of vitamin B12 deficiency is based on clinical presentation, neurological and psychiatric findings, cognitive testing, and laboratory diagnostics, which include circulating and functional biomarkers. Replenishment of cobalamin deficiency is equally effective via parenteral and oral routes if adequate doses are administered. Conclusion: Vitamin B12 deficiency is relatively common among children and adolescents, and it leads to neurological and psychiatric impairments that, if left untreated, can result in irreversible changes.