Does Vitamin B12 (Cobalamin) deficiency cause hypertriglyceridemia?

From the Guidelines

Vitamin B12 deficiency does not have a direct, established link to increased serum triglycerides, and management of hypertriglyceridemia should focus on lifestyle interventions and therapies aimed at reducing triglyceride levels, as outlined in recent guidelines such as the 2021 ACC expert consensus decision pathway 1. When considering the relationship between vitamin B12 deficiency and serum triglyceride levels, it's essential to differentiate between association and causation. While B12 deficiency can lead to various metabolic issues, the direct impact on triglyceride levels is not clearly defined in the medical literature. Key factors influencing triglyceride levels include diet, physical activity, weight management, and the presence of other metabolic risk factors such as diabetes and obesity, as noted in the context of managing severe hypertriglyceridemia 1. Some points to consider in managing elevated triglycerides include:

• Lifestyle interventions, such as Medical Nutrition Therapy (MNT), are crucial for all patients with elevated triglycerides, with specific dietary recommendations based on the severity of hypertriglyceridemia 1.
• For patients with severe hypertriglyceridemia (triglycerides ≥500 mg/dL), therapies should aim to reduce both chylomicrons and VLDL, with a rigorous approach to diet and potentially pharmacological interventions.
• The management of B12 deficiency, when present, involves supplementation, typically starting with high doses (e.g., 1,000 mcg daily) and then maintaining appropriate levels, which is important for overall health but not specifically targeted at lowering triglycerides. Given the current evidence, the primary approach to managing elevated serum triglycerides should adhere to established guidelines focusing on lifestyle modifications and, when necessary, pharmacological therapies, rather than solely addressing vitamin B12 deficiency 1.

From the Research

Vitamin B12 Deficiency and Serum Triglycerides

• The relationship between vitamin B12 deficiency and serum triglycerides is explored in several studies 2, 3.
• A study published in 2021 found that vitamin B12 deficiency can lead to increased hepatic fatty infiltration through altered fatty acid metabolism, resulting in elevated intracellular triglycerides 2.
• The study used HepG2 cells cultured in B12-deficient medium and found that low B12 levels increased lipid droplets, total intracellular triglycerides, and incorporation of radio-labelled-fatty acid in triglyceride synthesis 2.
• Another study published in 2017 discussed the role of vitamin B12 in cellular metabolism, including DNA synthesis, methylation, and mitochondrial metabolism, but did not specifically address the relationship between B12 deficiency and serum triglycerides 3.
• Other studies focused on the diagnosis, management, and prevalence of vitamin B12 deficiency, but did not explore its relationship with serum triglycerides 4, 5, 6.

Key Findings

• Vitamin B12 deficiency can lead to increased fatty acid synthesis and levels of individual fatty acids, and decreased fatty acid oxidation and mitochondrial respiration 2.
• Low B12 levels can result in dysregulation of lipid metabolism, potentially leading to elevated serum triglycerides 2.
• The exact mechanisms and clinical implications of the relationship between vitamin B12 deficiency and serum triglycerides require further investigation.