Risk of persistent cobalamin deficiency in adolescents fed a macrobiotic diet in early life

Am J Clin Nutr. 1999 Apr;69(4):664-71. doi: 10.1093/ajcn/69.4.664.


Background: Cobalamin deficiency has been described in children consuming macrobiotic diets.

Objective: We investigated whether moderate consumption of animal products is sufficient for achieving normal cobalamin function in 73 adolescents who had received a macrobiotic diet until 6 y of age and had then switched to a lactovegetarian, lactoovovegetarian, or omnivorous diet (macrobiotic adolescents).

Design: Hematologic indexes and serum concentrations of methylmalonic acid (MMA), total homocysteine (tHcy), and folate were measured. Current consumption frequency of animal products and cobalamin intake from dairy products were assessed by questionnaire. Data from 94 age-matched adolescents who received an omnivorous diet from birth were used as a reference.

Results: Serum cobalamin concentrations were significantly lower and concentrations of MMA and folate and mean corpuscular volume (MCV) were significantly higher in macrobiotic adolescents than in control adolescents: of macrobiotic adolescents, 21% had abnormal MMA concentrations (>0.41 micromol/L), 37% had abnormal cobalamin concentrations (<218 pmol/L), 10% had abnormal tHcy concentrations (> 12.8 micromol/L), and 15% had abnormal MCV (> 89 fL). In macrobiotic adolescents, dairy products (200 g milk or yogurt and 22 g cheese/d) supplied on average 0.95 microg cobalamin/d; additionally, these adolescents consumed fish, meat, or chicken 2-3 times/wk. In girls, meat consumption contributed more to cobalamin status than the consumption of dairy products, whereas in boys these food groups were equally important.

Conclusions: A substantial number of the formerly strict macrobiotic adolescents still had impaired cobalamin function. Thus, moderate consumption of animal products is not sufficient for restoring normal cobalamin status in subjects with inadequate cobalamin intake during the early years of life.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anthropometry
  • Case-Control Studies
  • Child
  • Diet, Macrobiotic / adverse effects*
  • Female
  • Follow-Up Studies
  • Hematinics / blood
  • Humans
  • Male
  • Methylmalonic Acid / blood
  • Netherlands / epidemiology
  • Nutritional Status
  • Vitamin B 12 / blood
  • Vitamin B 12 Deficiency / epidemiology
  • Vitamin B 12 Deficiency / etiology*


  • Hematinics
  • Methylmalonic Acid
  • Vitamin B 12