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Highlighting the Prevalence of Vitamin B12 Deficiency Among Children and Adults without Small Bowel Reconstruction: Institutional Comparison to the NHANES Data
Jin Kyu (Justin) Kim, MD, MS, Zachary Earldey, MD, Zoe Gückien, MD, MBA, Konrad Szymanski, MD, MPH, Nikhil Batra, MD, Richard Rink, MD, Mark Cain, MD, Shelly King, MSN, Martin Kaefer, MD, Kirstan Meldrum, MD, Rosalia Misseri, MD, Joshua Roth, MD, PhD.
Riley Hospital for Children, Indianapolis, IN, USA.
BACKGROUND:Patients with meningomyelocele may have impaired gastrointestinal motility, chronic constipation, and small intestinal bacterial overgrowth (SIBO),which may contribute to potential vitamin B12 deficiency. However, vitamin B12 deficiency is often discussed only in context of reconstruction using distal ileum. Therefore, we aim to assess the prevalence of vitamin B12 deficiency among individuals with spina bifida without prior longstanding urologic reconstruction involving the small bowel and to compare these findings with prevalence estimates from the general population.
METHODS:The prevalence of vitamin B12 deficiency was evaluated in both pediatric and adult individuals with spina bifida patients who had no urologic reconstruction involving the small bowel or underwent that type of reconstruction ≤5 years before their first vitamin B12 measurement. A total of 15,914 serum vitamin B12 measurements from participants aged ≥3 years old from the 1999 to 2002 National Health and Nutrition Examination Survey were included as the comparison population.
RESULTS:Among identified patients with myelomeningocele (n=317), vitamin B12 deficiency was significantly more common among adults than pediatric patients [21/158 (13.3%) vs 8/159 (5.0%), p= 0.01]. No significant differences in vitamin B12 deficiency were observed according to sex, race, or Distressed Communities Index quintile. The prevalence of vitamin B12 deficiency was 9.1% (29/317) in the spina bifida cohort compared with 1.6% (256/15,914) in the NHANES population. Individuals with spina bifida had significantly greater odds of having vitamin B12 deficiency compared with the NHANES population (OR 6.16, 95% CI 4.12 - 9.2, p < 0.001).
CONCLUSIONS:Our findings suggest that individuals with spina bifida may have an increased prevalence of vitamin B12 deficiency, including those without prior or longstanding urologic reconstruction involving the small bowel. These results support consideration of routine screening for vitamin B12 deficiency in this potentially high-risk population. Future prospective studies are needed to better define the temporal relationship between risk factors for developing vitamin B12 deficiency among the spina bifida population.
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