Trends in vitamin B12 and folate deficiency in Southern Iran (2018-2023): a retrospective laboratory-based surveillance study and implications for public health monitoring.
6 affiliations
- 1Hematopathology division, Department of pathology, school of medicine, Shiraz University of medical sciences, Shiraz, Iran.
- 2Molecular pathology and cytogenetic division, Department of pathology, school of medicine, Shiraz University of medical sciences, Shiraz, Iran.
- 3Hematology research center, Shiraz University of Medical Science, Shiraz, Iran.
- 4Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.
- 5Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran. [email protected].
- 6Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. [email protected].
Abstract
Background
Vitamin B12 and folate deficiencies remain significant public health challenges globally, contributing to hematological, neurological, and metabolic disorders. Routine clinical laboratory data offer a cost-effective opportunity to monitor nutritional trends, particularly in middle-income countries.Methods
This retrospective cross-sectional study analyzed routine, physician-requested test results from 25,505 individuals (vitamin B12) and 10,874 individuals (folate) tested at a central clinical laboratory in Fars Province, southern Iran, between 2018 and 2023. Deficiency was defined using manufacturer-recommended ELISA cutoffs (<160 pg/mL for B12; <4 ng/mL for folate). Prevalence rates were stratified by sex, age group (<18 vs. ≥18 years), and geographic location.Results
Overall deficiency rates were remarkably low: 3.9% for vitamin B12 and 3.3% for folate, with consistent patterns across sexes, age groups, and cities within the province. When standardized to a <200 pg/mL cutoff for comparability with prior regional studies, B12 deficiency prevalence was 8.7% (2,231/25,505), which remains substantially lower than historical reports (36.2%). Deficiency rates remained below 5% across nearly all subregions.Conclusion
The observed decline in vitamin B12 and folate deficiency suggests a positive shift in the nutritional status of individuals undergoing routine clinical testing. This trend may partially reflect expanded fortification programs, strengthened primary healthcare services, and increased supplement utilization. However, because these data originate from a clinical laboratory setting, they reflect the nutritional status of individuals undergoing physician-requested diagnostic or routine testing, rather than a randomly sampled, asymptomatic general population. Therefore, these findings should not be directly generalized to the broader community of Fars Province without caution. These findings highlight the utility of aggregated laboratory data as a pragmatic surveillance tool and support sustained public health interventions to maintain micronutrient adequacy.they reflect the nutritional status of individuals undergoing physician-requested diagnostic or routine testing, rather than a randomly sampled, asymptomatic general population. Therefore, these findings should not be directly generalized to the broader community of Fars Province without caution. Nevertheless, these results highlight the utility of aggregated laboratory data as a pragmatic surveillance tool and support sustained public health interventions to maintain micronutrient adequacy.
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BibTeX
@article{shokripour2026trends,
title = {{Trends in vitamin B12 and folate deficiency in Southern Iran (2018-2023): a retrospective laboratory-based surveillance study and implications for public health monitoring.}},
author = {Mansoureh Shokripour and Fatemeh Asadi and Navid Omidifar and Vahid Mohammadkarimi and Samira Taravatmanesh and Naeimehossadat Asmarian},
journal = {BMC public health},
year = {2026},
month = aug,
doi = {10.1186/s12889-026-28874-0},
url = {https://europepmc.org/article/MED/43009852},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Trends in vitamin B12 and folate deficiency in Southern Iran (2018-2023): a retrospective laboratory-based surveillance study and implications for public health monitoring.
AU - Mansoureh Shokripour
AU - Fatemeh Asadi
AU - Navid Omidifar
AU - Vahid Mohammadkarimi
AU - Samira Taravatmanesh
AU - Naeimehossadat Asmarian
PY - 2026
DA - 2026/08/04
JO - BMC public health
DO - 10.1186/s12889-026-28874-0
UR - https://europepmc.org/article/MED/43009852
AB - Background Vitamin B12 and folate deficiencies remain significant public health challenges globally, contributing to hematological, neurological, and metabolic disorders. Routine clinical laboratory data offer a cost-effective opportunity to monitor nutritional trends, particularly in middle-income countries.Methods This retrospective cross-sectional study analyzed routine, physician-requested test results from 25,505 individuals (vitamin B12) and 10,874 individuals (folate) tested at a central clinical laboratory in Fars Province, southern Iran, between 2018 and 2023. Deficiency was defined using manufacturer-recommended ELISA cutoffs (<160 pg/mL for B12; <4 ng/mL for folate). Prevalence rates were stratified by sex, age group (<18 vs. ≥18 years), and geographic location.Results Overall deficiency rates were remarkably low: 3.9% for vitamin B12 and 3.3% for folate, with consistent patterns across sexes, age groups, and cities within the province. When standardized to a <200 pg/mL cutoff for comparability with prior regional studies, B12 deficiency prevalence was 8.7% (2,231/25,505), which remains substantially lower than historical reports (36.2%). Deficiency rates remained below 5% across nearly all subregions.Conclusion The observed decline in vitamin B12 and folate deficiency suggests a positive shift in the nutritional status of individuals undergoing routine clinical testing. This trend may partially reflect expanded fortification programs, strengthened primary healthcare services, and increased supplement utilization. However, because these data originate from a clinical laboratory setting, they reflect the nutritional status of individuals undergoing physician-requested diagnostic or routine testing, rather than a randomly sampled, asymptomatic general population. Therefore, these findings should not be directly generalized to the broader community of Fars Province without caution. These findings highlight the utility of aggregated laboratory data as a pragmatic surveillance tool and support sustained public health interventions to maintain micronutrient adequacy.they reflect the nutritional status of individuals undergoing physician-requested diagnostic or routine testing, rather than a randomly sampled, asymptomatic general population. Therefore, these findings should not be directly generalized to the broader community of Fars Province without caution. Nevertheless, these results highlight the utility of aggregated laboratory data as a pragmatic surveillance tool and support sustained public health interventions to maintain micronutrient adequacy.
SN - 1471-2458
ER -