We appreciate the letter by Dr. Spence advocating the use of methylcobalamin or hydroxycobalamin
rather than the cyanocobalamin form of vitamin B12 (B12) in future clinical trials
investigating the efficacy of B vitamins to prevent or treat NASH.
[1]
This is similar to the concern that he raised previously regarding studies that employed
B12 for the prevention of stroke.
Spence JD, B vitamins for NASH: use methylcobalamin, not cyanocobalamin, J Hepatol2023;78:e34–e35 https://dx.doi.org/10.1016/j.jhep.2022.08.019
[3]
,[4]
Although several large trials previously showed no benefit of folate and/or B vitamins
(B6 and B12) in reducing cardiovascular events,
[4]
reanalysis of data from one of them (the VISP trial) showed there was a 34% reduction
in stroke/myocardial infarction events over 2 years when patients with impaired renal
function were excluded.
[5]
Subsequent studies using folate supplementation of enalapril in the China Stroke
Primary Prevention trial and folate, B6, and low dose B12 in the Su.Fol.M3 trial also
showed beneficial stroke prevention effects.
[6]
,[7]
Almost all clinical studies for stroke prevention by B12 to date were conducted with
cyanocobalamin. Dr. Spence has argued that the use of cyanocobalamin in individuals
with renal impairment may have obscured the benefit of B vitamins in stroke prevention
in earlier studies,
[2]
,[3]
,[5]
since it possible that increased cyanocobalamin leads to harmful accumulation of
cyanide and thiocyanate in patients with impaired renal function.
[8]
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References
Spence JD, B vitamins for NASH: use methylcobalamin, not cyanocobalamin, J Hepatol2023;78:e34–e35 https://dx.doi.org/10.1016/j.jhep.2022.08.019
- B vitamins in stroke prevention: time to reconsider.Lancet Neurol. 2017 Sep; 16: 750-760https://doi.org/10.1016/S1474-4422(17)30180-1
- Problem in the recent American heart association guideline on secondary stroke prevention: B vitamins to lower homocysteine do prevent stroke.Stroke. 2022; 53: 2702-2708
- The role of vitamin B in stroke prevention. A journey from observational studies to clinical trials and critique of the VITAmins to prevent stroke (vitatops).Stroke. 2011; 42: 838-842
- Vitamin intervention for stroke prevention trial: an efficacy analysis.Stroke. 2005; 36: 2404-2409
- Efficacy of folic acid therapy on the progression of chronic kidney disease: the renal sub study of the China stroke primary prevention trial.JAMA Intern Med. 2016; 176: 1443-1450
- Effects of B vitamins and omega 3 fatty acids on cardiovascular diseases: a randomised placebo-controlled trial.BMJ. 2010; 341: c6273
- Abnormal cyanide metabolism in uraemic patients.Nephrol Dial Transpl. 1997; 12: 1622-1628
- The effects of vitamin B12 supplementation on metabolic profile of patients with non-alcoholic fatty liver disease: a randomized controlled trial.Scientific Rep. 2022; 1214047
Article info
Publication history
Published online: October 14, 2022
Accepted:
October 7,
2022
Received:
October 5,
2022
Identification
Copyright
© 2022 Published by Elsevier B.V. on behalf of European Association for the Study of the Liver.
