Total homocysteine, vitamin B(12), and total antioxidant status in vegetarians

Clin Chem. 2001 Jun;47(6):1094-101.


Background: Decreasing or eliminating animal products from the diet decreases the intake of some essential nutrients, such as vitamin B(12), which may lead to hyperhomocysteinemia. We investigated vitamin B(12)-dependent metabolism and oxidative stress in groups with various or no intake of meat or animal products.

Methods: We investigated 44 high meat eaters, 19 low meat eaters, 34 lacto-ovo/lacto vegetarians, and 7 vegan vegetarians. Homocysteine (HCY) was assayed by HPLC, methylmalonic acid (MMA) by capillary gas chromatography-mass spectrometry, serum folate and vitamin B(12) with a chemiluminescence immunoassay, and total antioxidant status (TAS) by a Randox method.

Results: The mean serum HCY concentration of vegetarians was significantly increased, and in vegans the median concentration exceeded 15 micromol/L. Vegetarians had a higher serum concentration of MMA but a lower TAS. Vitamin B(12) and folate did not differ significantly between vegetarian and omnivorous subjects. Overall, HCY and MMA were significantly correlated. Vitamin B(12) correlated negatively with MMA, HCY, and folate, whereas the correlation with TAS was positive. Backward regression analysis revealed an independent influence of MMA on HCY, of HCY and vitamin B(12) on MMA, and of vitamin B(12) on TAS. The increased MMA concentration suggested a 25% frequency of functional vitamin B(12) deficiency in all vegetarians. Serum vitamin B(12) was below the lower reference limit in only five subjects.

Conclusions: Functional vitamin B(12) deficiency in vegetarians may contribute to hyperhomocysteinemia and decreased TAS, which may partly counteract the beneficial lifestyle of vegetarians. However, increased serum HCY is most likely not responsible for the lower TAS values in vegetarians. We recommend assaying of MMA and HCY to investigate functional vitamin B(12) status.

MeSH terms

  • Adult
  • Antioxidants / analysis*
  • Diet, Vegetarian*
  • Female
  • Homocysteine / blood*
  • Humans
  • Male
  • Middle Aged
  • Vitamin B 12 / blood*
  • Vitamin B 12 Deficiency / blood


  • Antioxidants
  • Homocysteine
  • Vitamin B 12