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Association of vitamin B12 with obesity, overweight, insulin resistance and metabolic syndrome, and body fat composition; primary care-based study


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Aim: To investigate correlation of vitamin B12 with obesity insulin resistance, metabolic syndrome. Methods: The cross-sectional and primary care-based study was carried out. Anthropometric, blood pressure measurements and bioelectric impedance analysis (BIA) were recorded. Vitamin B12, folic acid, hemogram, insulin, ferritin, iron, total iron binding capacity and other biochemical tests were assayed. The subjects were grouped as obesity, overweight, control, metabolic syndrome (MetS) and insulin resistance (IR). Correlation of vitamin B12 with body mass index (BMI), IR, age, and BIA was evaluated. Results: The study enrolled 976 patients (obesity: 414, overweight: 212, and control: 351). The mean age in groups of obesity, overweight and control were 35.9 ± 8.7, 28.9 ± 6.3 and 33.1 ± 8.7, respectively (p = 0.142). Vitamin B12 level was significantly lower in patients with obesity and overweight than healthy individuals (178.9 ± 25.2; 219.8 ± 78.5, and 328.5 ± 120.5, p less than 0.001, respectively). Vitamin B12 level was lower in patients with MetS (+/-) and IR (+/-), but insignificant (p = 0.075 and 0.058, respectively). Significant and negative correlation was observed between vitamin B12 and BMI (r =-0.221, p=0.001). No significant difference was observed between obese male and female patients (247.8 ± 89.1 versus 235.5 ± 89.3 pg/mL, respectively, p=0.090). Conclusion: Low Vitamin B12 level was associated with obesity and overweight, but not with insulin resistance, metabolic syndrome and gender. Vitamin B12 was negatively correlated only with body mass index.
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Association of vitamin B12 with obesity, overweight, insulin
resistance and metabolic syndrome, and body fat composition;
primary care-based study
Davut Baltaci
, Ali Kutlucan
, Yasemin Turker
, Aylin Yilmaz
, Serkan Karacam
, Harun Deler
, Taner
, Ismail Hamdi Kara
Department of Family Medicine,
Department of Internal Medicine,
Family Medicine Office,
Department of Biochemistry; Duzce Univer-
sity, School of Medicine, Duzce, Turkey
Corresponding author:
Davut Baltaci
Department of Family Medicine,
School of Medicine, Duzce University
Konuralp, Duzce, 81620, Turkey
Phone: +90 380 54 213 90;
Fax: +90 380 54 213 87;
Original submission:
24 December 2012;
Revised submission:
03 January 2013;
24 January 2013.
Aim To investigate correlation of vitamin B12 with obesity insulin
resistance, metabolic syndrome.
Methods The cross-sectional and primary care-based study was
carried out. Anthropometric, blood pressure measurements and bi-
oelectric impedance analysis (BIA) were recorded. Vitamin B12,
folic acid, hemogram, insulin, ferritin, iron, total iron binding
capacity and other biochemical tests were assayed. The subjects
were grouped as obesity, overweight, control, metabolic syndro-
me (MetS) and insulin resistance (IR). Correlation of vitamin B12
with body mass index (BMI), IR, age, and BIA was evaluated.
Results The study enrolled 976 patients (obesity: 414, overweight:
212, and control: 351). The mean age in groups of obesity, overwe-
ight and control were 35.9 ± 8.7, 28.9 ± 6.3 and 33.1 ± 8.7, res-
pectively (p = 0.142). Vitamin B12 level was signicantly lower
in patients with obesity and overweight than healthy individuals
(178.9 ± 25.2; 219.8 ± 78.5, and 328.5 ± 120.5, p < 0.001, respecti-
vely). Vitamin B12 level was lower in patients with MetS (+/-) and
IR (+/-), but insignicant (p = 0.075 and 0.058, respectively). Si-
gnicant and negative correlation was observed between vitamin
B12 and BMI (r =-0.221, p=0.001). No signicant difference was
observed between obese male and female patients (247.8 ± 89.1
versus 235.5 ± 89.3 pg/mL, respectively, p=0.090).
Conclusion Low Vitamin B12 level was associated with obesity
and overweight, but not with insulin resistance, metabolic syndro-
me and gender. Vitamin B12 was negatively correlated only with
body mass index.
Keywords: vitamin B12, obesity, insulin resistance, bioelectric
impedance analysis
Med Glas (Zenica) 2013; 10(2):203-210
Medicinski Glasnik, Volume 10, Number 2, August 2013
Obesity is a chronic and complex diseases de-
ned as an excess in body fat, and it is associated
with many medical problems (1, 2). People with
obesity are at great risk for diseases of metabo-
lic, cardiovascular, and mechanic disorders (3,
4). Due to continuous increase in prevalence,
it has become one of the most important public
health problems in the world and diseases en-
countered by family physicians in primary care
settings (5-7). In recent studies, vitamin deci-
encies, particularly vitamin D and B12, in obese
patients were reported. Vitamin B12 is required
in DNA synthesis and red blood cell. It is invol-
ved in myelination in central nervous system. Vi-
tamin B-12, also known as cobalamin, is one of
many vitamins belonging to vitamin B-complex.
It occurs naturally in some foods such as meat,
sh, shellsh and dairy products. Its absorption is
complex and involves several steps (8, 9).
Vitamin B12 deciency is often under-diagno-
sed, thus it is not routinely tested by most family
physicians and laboratory reference is not well
dened. True prevalence of vitamin B
cy in general population is unknown (10, 11). It
results from decreased intake, abnormal nutrient
absorption, and rare inborn disorder of vitamin
metabolism. Abnormal absorption may be
due to medications that decrease gastric acid se-
cretion, pernicious anemia, infection with giardia
lamblia, and any disruption of the ileal mucosa
such as Crohn and celiac disease (12). Although
dietary habits of obese children may be with con-
sumption of high quantity of carbohydrate and
fat and low in proteins from animal sources that
contain vitamin B12. It was suggested that obesi-
ty could impair absorption and indirectly inborn
errors of vitamin B12 metabolism. It was also re-
ported that poor dietary content, repeated short-
term restrictive diets and increased requirements
were often seen in obese adults, and thus resulted
in vitamin various deciencies (13-15).
Most studies reported on association of obesity
with iron and vitamin deciencies in children,
but, the number of studies in adults are inconsi-
derable (15,16). Some of these studies reported
that vitamin B12 deciency was associated with
obesity, while some reported that it was not asso-
ciated (17-20).
The present study aimed to investigate associati-
on between vitamin B12 deciency and patients
with obesity and overweight, metabolic syndro-
me and insulin resistance.
The study design and population
The study was designed as a cross-sectional case
control. It was primary care-based study carried
out in a family medicine clinic between May 2011
and June 2012. The patients who were admitted
to the family medicine clinic of Duzce University,
School of Medicine, Department of Family Me-
dicine. All subjects gave oral informed consents.
The patients with diabetes mellitus, pregnancy,
pace-makers, end-stage renal disease, and chro-
nic obstructive pulmonary disease were excluded.
Also, the patients under current treatment of corti-
costeroids, metformin, vitamin supplements, and
long-term proton pump inhibitors (PPIs) used for
more than 3 months. Age-matched lean healthy
individuals were enrolled as a control group. The
study was approved by the Ethic Committee of
Duzce University, School of Medicine.
Obesity and overweight, insulin resistance and
metabolic syndrome definition
Obesity and overweight were dened as BMI 30
and 24.9 < BMI < 30.0 kg/m
according to
the WHO criteria (21). Insulin resistance (IR) was
accepted as HOMA-IR (Homeostasis Model of
Assessment - Insulin Resistance) 2.5 (22). The
HOMA-IR was calculated by formulation: (fasting
glucose-mg/dL) x (fasting insulin-µU/mL) / 405.
Metabolic syndrome (MetS) was dened as crite-
ria recommended by the NCEP ATP III (National
Cholesterol Education Program Adult Treatment
Panel III) and considered if the subject had at least
three of the following ve criteria: waist circumfe-
rence (WC) > 102 cm (male) or > 88 cm (female);
blood triglyceride (TG) level 150 mg/dL, HDL
cholesterol (HDL-chol) < 40 mg/dL (male) or < 50
mg/dL (female), or under treatment of anti-lipid
agents; blood pressure ≥ 130/85 mm-Hg or under
treatment of anti-hypertensive agents; and fasting
blood glucose level ≥ 110 mg/dL or presence of di-
abetes mellitus (23). The MetS subgroup was for-
med with patients with obesity. IR subgroup was
formed with both obese and overweight patients.
Measurements of blood pressure and anthropo-
metric parameters
All measurements were taken by two family physi-
cians after adequate training in these procedures.
Blood pressure (BP) was measured in sitting po-
sition on the right arm using a sphygmomanome-
ter (Erka, Germany), after at least 5 minutes of
resting and avoiding smoking and drinks conta-
ining alcohol and caffeine. The rst appearance
and disappearance of Korotkoff sounds were used
to dene the blood pressures. Readings were re-
corded to nearest even number and mean of two
recordings 3 min interval was computed.
Waist circumference (WC) was measured with
subjects standing and wearing only underwear,
using a stadiometer crossing midway between
the lower rib margin and the iliac crest. Hip
circumference (HP) was measured at the level
of the greater trochanter. Height was measured
with stadiometer to the nearest 0.5 cm with su-
bjects barefoot, standing in erect position with
heels together and looking straight ahead. Wei-
ght was measured with a bioelectric impedance
body fat analyzer after checking for zero point
at each measurement, when subjects were wei-
ghed barefoot, standing still and without support,
in light clothing after removing belts and other
accessories and pockets. Body mass index (BMI)
was calculated by a computer as weight divided
by height squared (kg/m
Bioelectric impedance body fat analysis
A hand-to-foot single frequency biochemical im-
pedance analyzer with 50 kHz (Tanita, BF-510,
Omron, and Netherland) was used. After entering
the patients’ data such as height, age and gender
in the BIA, electrodes were placed on their hand
and foot. The subjects were fasting and were ba-
refoot wearing light clothing. All metallic acce-
ssories were removed. The patients with pace-
makers or pregnancy were excluded.
Biochemical analysis
Blood samples were taken from all subjects
between 08:00 and 10:00 after at least an 8-ho-
ur overnight fasting. All samples were assayed
within the same day when taken. Blood samples
for Hemogram test were drawn into a tube with
ethylenediaminetetraacetic acid (ETDA). Lipid
prole tests were assayed using the colorime-
tric method (Cobas 6000 C 501, Roche Diagno-
stic GmbH, and Mannheim Germany). Insulin,
Thyroid stimulating hormone, Vitamin B12 and
folic acid levels were assayed with solid-phase
2-site chemiluminescent immunometric assay, so-
lid-phase competitive chemiluminescent enzyme
immunoassay, solid-phase chemiluminescent
immunometric assay, and competitive immuno-
assay, respectively (IMMULITE 2000, Siemens
Healthcare Diagnostic, and Flanders, NJ, USA).
Low density lipoprotein-cholesterol (LDL-Chol)
was calculated using the Friedewald equation.
Vitamin B12 status
Vitamin B12 status was determined according
to criteria dened by Stabler (24). Based on
the criteria, vitamin B12 status was categorized
as three: vitamin B12 deciency if blood level
of vitamin B12 was < 200 pg/mL, as marginal
if vitamin B12 between 200-300 pg/mL and as
adequate if vitamin B12 > 300 pg/mL.
Statistical methods
The continuous variables were stated as mean ±
standard deviation (SD). The categorical variables
were stated as percentage. Normality distribution
was evaluated with Kolmogorov-Smirnow test.
All parameters in the study were normally distri-
buted. Independent continuous variables between
two groups were analyzed with Student-T test.
Independent continuous variables normally dis-
tributed between more than two groups were
analyzed with ANOVA test, Bonferroni. Correla-
tion of vitamin B12 with BMI, IR, total fat (kg)
and total fat (%) was analyzed with Pearson’s
correlation. Lineer regression analysis was used
for correlation between BMI, insulin resistance,
total fat (%) and total fat (kg). Signicance was
accepted, if p value was less than 0.05.
The study enrolled 976 patients, 414 with obesity
(66.9 % females and 33.1% males), 212 overwei-
ghed (67.9 % females and 32.1 % males), and 351
controls (75.4 % females and 24.6 % males) (p =
0.117). The mean age of the patients in the group
with obesity was 35.9 ± 8.7 (21-53 years-old), in the
overweight group 28.9 ± 6.3 (22-42 years-old), and
in controls 33.1 ± 8.7 (19-51 years-old) (p > 0.05).
Baltaci et al. Vitamin B12 and Obesity
Medicinski Glasnik, Volume 10, Number 2, August 2013
Body fat analysis with bioelectrical impedance of
patients from groups was shown. The result of in-
dividuals in the control group was signicantly di-
fferent from the patients with obesity and overwe-
ight (p<0.001 for total fat % and p<0.001 for total
fat kg). Systolic and diastolic blood pressure of
patients in control group were comparably lower
than in the obese and overweight groups (p<0.001
and p=0.003; p<0.001 and p<0.001, respectively).
Hemoglobin level (Hb) in the control group was
slightly lower than in other groups, but not signi-
cantly (12.8 ± 1.4 mg/dL, 13.2 ± 0.8 mg/dL, and
13.4 ± 2.1 mg/dL, respectively) (p > 0.05). It was
observed that insulin resistance was signicantly
higher among the patients with obesity than tho-
se with lean body and overweight (p=0.001 and
p<0.001), but there was no signicant difference
between participants with lean body and overwe-
ight (p=0.153) (Table 1).
pg/mL), respectively (p<0.001) (Table 2). Vita-
min B12 level in the overweight group was also
lower than in obese patients, but it was not signi-
cant (p>0.05). There were no signicant diffe-
rences in folic acid, ferritin, TS and MCV values
between groups (p=0.677, p=0.132, p=0.554, and
p=0.399, respectively). Vitamin B12 level was
lower in subgroups of metabolic syndrome (+/-)
and insulin resistance (+/-), but not signicant
(p=0.075 and p=0.058, respectively). The compa-
rison of other values, folic acid, ferritin, TS and
MCV between subgroups showed no statistical
signicance. Hemoglobin levels in subgroups of
metabolic syndrome and insulin resistance were
not different (Table 3, 4)
Body Mass Index Group
(n = 414)
(n = 212)
(n = 351)
35.9 ± 8.7 28.9 ± 6.3 33.1 ± 8.7
0.273, 0.096,
124.8 ± 14.3 112.2 ± 6.4 111.8 ± 8.3
0.005, <0.001,
81.1 ± 11.2 73.6 ± 4.8 71.9 ± 5.5
0.003, 0.001,
151.2 ± 90.4 125.4 ± 58.3 88.9 ± 38.4
0.024, <0.001,
45.6 ± 10.1 56.3 ± 9.3 64.9 ± 15.5
0.001, <0.001,
106.7 ± 28.5 105.1 ± 10.7 102.9 ± 32.5
<0.001, <0.001,
37.5 ± 4.9 28.2 ± 1.6 22.1 ± 2.2
<0.001, <0.001
98.9 ± 13.7 88.2 ± 5.1 88.9 ± 6.5
<0.001, <0.001,
Total Fat
42.6 ± 9.1 37.9 ± 3.8 23.7 ± 7.9
<0.001, <0.001,
Total Fat
12.2 ± 4.7 6.1 ± 0.9 3.7 ± 1.4
<0.001, <0.001
26.2 ± 15.9 16.4 ± 8.9 14.9 ± 6.9
0.030, <0.001,
22.3 ± 6.7 14.2 ± 5.1 19.4 ± 6.4
0.005, 0.518,
Uric acid
4.9 ± 1.5 4.5 ± 0.6 3.9 ± 0.7
< 0.001, 0.012,
3.1 ± 2.1 1.3 ± 0.9 1.1 ± 0.8
0.153, < 0.001,
< 0.001
Table 1. Comparison of insulin resistance, anthropometric
and biochemical parameters in groups
* The signicance between three groups SBP, systolic blood pressure;
DPS, Diastolic Blood Pressure; TG, Triglyceride; HDL, High-density
lipoprotein; LDL, light-density lipoprotein; BMI, Body Mass Index;
FBG, Fasting Blood Glucose; ALT, Alaninaminotransferase; AST
Aspartateaminotransferase IR, Insulin Resistance;
Vitamin B12 level was signicantly lower in the
obese and overweight groups than in control gro-
up: 178.9 ± 25.2 (143.5-228 pg/mL), 219.8 ± 78.5
(124.1-498 pg/mL) and 328.5 ± 120.5 (148-540
Body Mass Index Group
(n = 414)
(n = 212)
(n = 351)
Vit B12
178.9 ± 25.2 219.8 ± 78.5 328.5 ± 120.5
< 0.001,< 0.001,
Folic acid
8.8 ± 3.7 8.2 ± 4.3 7.4 ± 3.9
0.887, 0.769,
60.1 ± 47.7 38.8 ± 19.9 33.3 ± 27.4
0.345, 0.157,
TS (%)
20.8 ± 9.2 28.1 ± 12.1 19.1 ± 9.6
0.898, 0.786,
83.3 ± 6.5 88.7 ± 4.8 83.1 ± 6.4
0.004, 0.238,
13.4 ± 2.1 13.2 ± 0.8 12.8 ± 1.4
< 0.001, 0.005,
Table 2. Comparison of vitamin B12, folic acid and hemato-
logical values in groups
TS, Transferrin saturation; MCV, Mean Corpuscular Volume; Vit
B12, Vitamin B12; Hb, Hemoglobin;
Metabolic Syndrome Group
MetS (+)
(Mean ± SD)
MetS (-)
(Mean ± SD)
Vit B12 (pg/mL)
241.4 ± 83.2 238.43 ± 94.2 0.075
Folic acid (ng/mL)
8.5 ± 3.8 8.3 ± 3.7 0.677
Ferritin (pg/L)
55.8 ± 45.4 46.4 ± 38.4 0.132
TS (%)
22.3 ± 12.1 21.5 ± 11.6 0.554
MCV (fL)
83.4 ± 8.1 84.1 ± 5.6 0.554
Hb (mg/dL)
13.7 ± 1.6 13.1 ± 1.1 0.412
Table 3. Comparison of vitamin B12, folic acid and hemato-
logical values in metabolic syndrome subgroup
TS, Transferrin saturation; MCV, Mean Corpuscular Volume; Vit
B12, Vitamin B12; Hb, Hemoglobin;
Insulin Resistance Group
IR (+)
(Mean ± SD)
IR (-)
(Mean ± SD)
Vit B12 (pg/mL)
243.56 ± 6.14 234.59 ± 87.8 0.058
Folic acid (ng/mL)
8.8 ± 3.9 8.3 ± 3.8 0.404
Ferritin (pg/L)
45.7 ± 42.8 58.6 ± 42.9 0.052
TS (%)
22.9 ± 13.1 21.7 ± 10.1 0.376
MCV (fL)
85.3 ± 8.1 84.2 ± 6.1 0.218
Hb (mg/dL)
13.3 ± 0.8 12.9 ± 1.5 0.083
Table 4. Comparison of vitamin B12, folic acid and hemato-
logical values in insulin resistance subgroup
IR, Insulin resistance;
up was quite higher in control group (40.1% and
37.7 % versus 17.1 %) (p<0.001) (Table 5). When
vitamin B12 level was compared between male
and female patients with obesity, no signicant
differences were observed (males: 248.1 ± 88.7
versus females: 234.3 ± 90.7, p=0.090 in obesity;
males: 236.6 ± 89.4 versus females: 269.9 ± 75.7,
p=0.075; and males: 291.6 ± 102.3 versus fema-
les: 301.7 ± 104.3, p = 0.981) (Figure 1).
Vitamin B12 Status
(N, %)
(N, %)
(N, %)
(N = 976)
Control (N = 351)
Overweight (N = 212)
Obesity (N = 414)
60 (17.1) 154 (44.0) 137 (38.9)
80 (37.7 ) 88 (41.5) 44 (20.8)
166 (40.1) 166 (40.3) 82 (19.6)
(N = 414)
MetS (+) (N = 244)
MetS (-) (N = 170)
101 (41.5) 99 (40.6) 44 (18.1)
65 (38.1) 69 (40.9) 36 (21.0)
(N = 626)
IR (+) (N = 314)
IR (-) (n = 312)
116 (36.8) 133 (42.4) 65 (20.8)
103 (32.9) 128 (41.1) 81 (26.0)
Table 5. Comparison of vitamin B12 status according to body
mass index, metabolic syndrome and insulin resistance
MetS, metabolic syndrome; IR, insulin resistance;
Figure 1. Comparison of vitamin B12 level between males and
females in obesity, overweight and control groups
Vitamin B12 status (decient, marginal and
adequate) was compared according to BMI,
MetS and IR groups. No signicant differences
for vitamin B12 status were observed in MetS
and IR groups (p=0.686 and p=0.284, respecti-
vely). However, signicant difference was obser-
ved between vitamin B12 status and BMI groups.
Accordingly, the percentage of patients with vita-
min B12 deciency in obese and overweight gro-
Figure 2. Correlation of vitamin B12 with BMI, IR, and body composition analysis. 2a) cor-
relation between vitamin B12 and total fat (kg) measured via bioelectric impedance analysis,
revealing significant but weak negative correlation (r = -0.090, p = 0.031); 2b) negative
and mild significant correlation between vitamin B12 and total fat (%) was demonstrated (r
=-0.230, p=0.001); 2c) moderate significant and negative correlation between itamin B12
and body mass index (r =-0.221, p=0.001); 2d) Vitamin B12 was significantly and negatively,
but weakly, correlated with insulin resistance (r =-0.078, p=0.048).
Baltaci et al. Vitamin B12 and Obesity
Medicinski Glasnik, Volume 10, Number 2, August 2013
Moderate signicant and negative correlation
was observed between vitamin B12 and BMI (r=
-0.221, p=0.001) but weak negative correlation
with insulin resistance, total fat (%) and total fat
(kg) was detected (r =-0.078, p=0.048; r =-0.230,
p=0.001, and r=-0.090, p=0.031, respectively) (Fi-
gures 2a, 2b, 2c, 2d). With linear regression anal-
ysis, it was found that only vitamin B12 was nega-
tively correlated with BMI: beta= -0.241, p=0.002
(95 % CI: -5.055 and -1.116), but not with age,
total fat (kg), total fat (%) and insulin resistance.
Vitamin B12 deciency is silent and common in
general population (10). Causes of Vitamin B12
deciencies are multifactorial and associated
with many health problems (8). Also, obesity is
common and its prevalence is increasing in the
world (2). Therefore, both health problems have
gained importance in family medicine practice in
the last decades.
To the best of our knowledge, the present study
was the rst study which investigated the associ-
ation of vitamin B12 with body fat analysis (total
fat % and total fat kg) in addition to BMI, IR, and
MetS in obese and overweight patients. The study
indicated that vitamin B12 deciency is common,
compared to healthy individuals. It is not more
frequent only in patients with obesity, but also in
those who are overweight. The study has shown
that vitamin B12 level was correlated only with
BMI, but not with IR, MetS, age and gender.
Vitamin B12 deciency in obesity, metabolic
syndrome and its relation with insulin resistance
was previously studied in several investigations
among Turkish population. Guven et al. (25) re-
ported that vitamin B12 level was signicantly
lower in patients with metabolic syndrome than
those without metabolic syndrome. Our study
has found that vitamin B12 level was also lower
in patients with metabolic syndrome than in the
patients with non-metabolic syndrome but not
signicantly. All patients with metabolic and
non-metabolic syndrome in our study were obe-
se, and it is the reason why we found no signi-
cant difference. Vitamin B12 and folic acid su-
pplement in patients with metabolic syndrome
improved insulin resistance and endothelial fun-
ction (26, 27). Therefore, we suggest that vita-
min B12 supplements may be better for patients
with metabolic syndrome who have decient or
marginal level of vitamin B12.
Kaya et al. conducted a study on association
between insulin resistance, obesity and vitamin
B12 in patients with polycystic ovary syndrome.
They concluded that obesity, insulin resistance
and elevated homocysteine level were associated
with vitamin B12 deciency (28). We investiga-
ted vitamin B12 deciency in general population
in the present study and found vitamin B12 corre-
lation with BMI, not with insulin resistance.
Previously reported study on the association
between vitamin B12 and obesity in middle-aged
women have shown a signicantly lower vitamin
B12 in obese women and negative
with BMI (29). The current study investigated a
correlation of vitamin B12 level with bioelectric
fat analysis in both male and female patients with
obesity and overweight, in addition to BMI, insu-
lin resistance, metabolic syndrome.
Obese people are not only at risk for vitamin
B12 deciency, but also for iron deciency. Pin-
has-Hamiel et al. (30) studied the association
between obesity/overweight and iron decien-
cy, and found that negative correlation of low
iron deciency with BMI, reporting the grea-
ter prevalence of iron deciency in obese and
overweight children and adolescents. In con-
trast, the results of this study have shown lower
but insignicant transferrin saturation and ferri-
tin level in the control group than in obese and
overweight patients.
Beside there was no signicant difference
between B12 level in males and females, male
subjects with obesity and overweight had more
vitamin B12 level, compared to female counter-
parts. In studies, various results regarding vita-
min B12 level between male and female indivi-
duals were reported (31-33).
In some studies, it was reported that vitamin B 12
deciencies were associated with long-term use
of metformin, histamine-2 blockers (H2-blocker)
and proton pump inhibitors (34,35). In our study,
the patients who had used metformin, PPIs and
H2-blocker agents for over 3 months were exc-
luded. Additionally, it was shown that helicobac-
ter pylori infection was associated with vitamin
B12 deciency in recent studies (36-38). It was
known that frequency of helicobacter pylori in-
fection and dyspeptic symptoms in obese patients
were common (39,41). The patients with obesity
tend to use intermittently PPIs or H2-blockers
to relieve dyspeptic complaints. Intermittent use
can also cause vitamin B12 deciency in obese
There were two limitations of the study. Firstly,
our study is cross-sectional. Secondly, serum ho-
mocysteine and methylmalonic acid level were
not assayed in the study. Homocysteine and
methylmalonic acid are used for determination
of vitamin deciency. Our study was primary
care- based study, so those laboratory tests are
not routinely used and they are not cost-effective
in family medicine clinics.
In conclusion, obesity and overweight are addi-
tional risk factors for vitamin B12 deciency. In
obesity, the reason for vitamin deciency is mul-
tifactorial and modiable. The physicians, parti-
cularly family physicians, should keep in mind
that vitamin B12 level may be lower than in non-
obese people. They should check B12 level in pa-
tients with obesity and overweight, although they
are asymptomatic.
We would like to thank our technicians and staff
members of biochemistry laboratory.
No specic funding was received for this study
Competing interests: none to declare.
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... 11 16 Moreover, up to 75% patients with type 2 diabetes presented low blood concentration of vitamin B1. 17 Vitamin B12 levels have also been linked with obesity with a significant negative correlation reported between body mass index (BMI) and vitamin B12 blood levels in a cohort of almost 1000 patients with obesity. 18 Moreover, the authors of this study also found a trend toward decreased vitamin B12 blood concentrations in subjects with insulin resistance or metabolic syndrome in comparison to participants without metabolic alterations. 18 In another cohort of participants with overweight or obesity, 13% of participants were found to be deficient in vitamin B12 19 while in the general US population, the prevalence of vitamin B12 deficiency was found to be around 5% and increases with age. ...
... 18 Moreover, the authors of this study also found a trend toward decreased vitamin B12 blood concentrations in subjects with insulin resistance or metabolic syndrome in comparison to participants without metabolic alterations. 18 In another cohort of participants with overweight or obesity, 13% of participants were found to be deficient in vitamin B12 19 while in the general US population, the prevalence of vitamin B12 deficiency was found to be around 5% and increases with age. 20 Interestingly, the serum levels of vitamin B12 are increased after a weight loss induced by a low energy diet (LED). ...
There are numerous factors involved in obesity progression and maintenance including systemic low‐grade inflammation, adipose tissue dysfunction, or gut microbiota dysbiosis. Recently, a growing interest has arisen for vitamins' role in obesity and related disorders, both at the host and gut bacterial level. Indeed, vitamins are provided mostly by food, but some, from the B and K groups in particular, can be synthesized by the gut bacterial ecosystem and absorbed in the colon. Knowing that vitamin deficiency can alter many important cellular functions and lead to serious health issues, it is important to carefully monitor the vitamin status of patients with obesity and potentially already existing comorbidities as well as to examine the dysbiotic gut microbiota and thus potentially altered bacterial metabolism of vitamins. In this review, we examined both murine and human studies, to assess the prevalence of sub‐optimal levels of several vitamins in obesity and metabolic alterations. This review also examines the relationship between vitamins and the gut microbiota in terms of vitamin production and the modulation of the gut bacterial ecosystem in conditions of vitamin shortage or supplementation. Furthermore, some strategies to improve vitamin status of patients with severe obesity are proposed within this review.
... Previous studies have found that serum vitamin B12 deciency is more common in obese individuals. However, the association between serum B12 concentrations and obesity has been inconsistent, although, B12 deciency is more prevalent among the obese population (15)(16)(17)(18)(19)(20)(21)(22)(23)(24). ...
Introduction: Vitamin B12, also known as cobalamin; has been implicated as an important factor in regulating various metabolic processes, thus playing a role in the etiology of obesity. To assess whether obese adults a Objectives: re at an increased risk for vitamin B12 deciency. This study aimed to assess the serum vitamin B12 status of obese Indians to see if there were any associations between body mass index (BMI) and serum B12 concentration. Medicine outpatient at a medical college university hospita Settings: Methods: l. We included 224 adult participants aged ≥19 years. Overweight and obesity were dened as BMI ≥ 25-29.9 kg/m2 and ≥ 30 kg/m2 respectively. The study subjects were divided into 2 groups as normal BMI (< 25 kg/m2) group, and the obese BMI (≥ 25 kg/m2) group. BMI was calculated as weight in kilograms divided by height in meters square. Fasting venous blood samples were taken from the subjects for the estimation of serum B12 concentrations which were measured using the fully automated electrochemiluminescence immunoassay. Low serum B12 was dened concentration < 197 pg/mL, and B12 deciency was dened as concentration below 150 pg/mL. The adjusted odds ratio (OR) and 95% condence interval (CI) were obtained by the binary logistic regression method. The correlation between serum B12 and BMI was calculated using Pearson's correlation coefcient (r) across various BMI categories. Serum B12 level was signicantly lower among obese adults compa Results: red with non-obese adults. There were signicant negative associations between BMI and serum B12 (p =0.004). Pearson correlation coefcient was strongly negatively associated for BMI with serum B12 level (r= -0.703, p<0.00001). Obesity in otherwise healthy adults was associated with Conclusions: an increased risk of serum B12 deciency. A negative association was found between serum B12 concentrations in obese adult subjects. This association was more pronounced with higher grades of obesity; further research at a large scale is needed to understand the underlying mechanisms and its prevalence in the obese population. We recommend that the possibility of vitamin B12 deciency should always be considered in obese adults.
... Then, we grouped the variables into the corresponding factors with the highest factor scores. Twelve nutrient variables-fat, monounsaturated fatty acids, saturated fatty acids, omega-6 fatty acid, polyunsaturated fatty acids protein, cholesterol, vitamin B2, phosphorus, vitamin B3, vitamin B1, and omega-3 fatty acid-demonstrated high factor scores in factor 1. Previous studies confirmed a correlation between fat and vitamin B, and fat intake and cholesterol [59,60]. We named factor 1 the "fatty acids and vitamin B family" in consideration of the commonality of nutrients. ...
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Cataracts are a prevalent ophthalmic disease worldwide, and research on the risk factors for cataracts occurrence is actively being conducted. This study aimed to investigate the relationship between nutrient intake and cataracts in the older adult population in Korea. We analyzed data from Korean adults over the age of 60 years (cataract: 2137, non-cataract: 3497) using the Korean National Health and Nutrition Examination Survey. We performed univariate simple and multiple logistic regressions, adjusting for socio-demographic, medical history, and lifestyle, to identify the associations between nutrient intake and cataracts. A higher intake of vitamin B1 in the male group was associated with a lower incidence of cataracts. A lower intake of polyunsaturated fatty acids and vitamin A, and a higher intake of vitamin B2 in the female group were associated with a higher incidence of cataracts. Our study demonstrated that polyunsaturated fatty acids, vitamin A, and vitamin B2 could affect the incidence of cataracts according to sex. The findings could be used to control nutrient intake for cataract prevention.
... In addition, studying morbidly obese women showed that 11% of them had an abnormal level of vitamin B12 [44]. However, there are some inconsistent results about the association of vitamin B12 and obesity [42,[45][46][47][48]. ...
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Obesity is an increasing problem that can lead to noncommunicable diseases. The role of dietary factors on one’s obesity is confirmed in many studies. One nutritional approach that can be used for assessment of the foods and diets is the Index of Nutritional Quality (INQ). Our study is aimed at exploring the association between INQ and obesity. Our hypothesis is that enriched and high-quality diets reduce the risk of overweight or obesity. This study was carried out on 6248 overweight and obese participants, from whom 4356 (69.7%) and 1892 (30.3%) were overweight and obese, respectively. To assess the dietary intake for the participants, a valid food frequency questionnaire (FFQ) with 130 food items was utilized. The analysis revealed an inverse association between the overweight and the INQ of iron, thiamin, riboflavin, B6, folate, zinc, magnesium, calcium, and vitamin C and E. For the obese group, this inverse association was found for iron, B6, folate, zinc, magnesium, calcium, and vitamin C and E. These results approved our hypothesis that a rich nutrition diet may lead to a lower risk of obesity.
... Vitamin B12 deficiency was shown to occur in 10.6% of women undergoing BS [33]. Interestingly, vitamin D deficiency was reported to be as high as 6% in women of childbearing age despite adequate intake [34], and vitamin B12 deficiency was shown to strongly correlate with overweight and obesity [35]. Among our BS candidates, the deficit of vit. ...
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Background Micronutrient deficiencies represent a common condition after bariatric surgery (BS). The prevalence of these nutritional disorders before BS is still debated. The aim of our study was to retrospectively evaluate the prevalence of micronutrient deficiencies in candidates for BS. Methods A prospectively maintained database of our institution was searched to find all patients who underwent surgery between January and December 2021. The following data were collected: age, gender, body mass index (BMI), obesity-associated diseases, and preoperative serum levels of vitamin B12, folate, and vitamin D. Results A total of 174 patients were included in our study. Mean age and BMI were 39.2 ± 11.4 years and 44.3 ± 7.1 kg/m², respectively. One hundred and thirty-nine patients (79.9%) had at least one preoperative micronutrient disorder, with vitamin D deficiency being the most common (116, 66.7%), followed by a deficit of folate (76, 43.7%) and vitamin B12 (10, 5.7%). Forty-seven (27%) individuals had insufficient levels of vitamin D. Comparison of deficiencies between sexes showed that vitamin B12 < 20 ng/ml was significantly more frequent in women (p = 0.03). DLP showed a mild significant effect on folate levels (p = 0.01), while the association of HNT and T2DM had a mild significant effect on vitamin B12 (p = 0.02). Conclusions Preoperative micronutrient deficiencies were frequently found in candidates for BS. Approximately 90% of patients had deficient or insufficient serum levels of vitamin D preoperatively. Almost half of the patients had a preoperative deficit of folate, and vitamin B12 deficiency was significantly more frequent in the female population. It is mandatory to screen all patients undergoing BS for vitamin deficiencies before surgery.
... NAFLD is strictly associated with obesity and higher glycated levels [61,62], with lower levels of folate and vitamin B12 [63,64], and a reduction in folate level [65]. More recently, NAFLD has been associated with higher levels of homocysteine [66] and most probably hypovitaminosis D [13,66]. ...
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NAFLD is the most common cause of abnormality in liver function tests. NAFLD is considered a potential cardiovascular risk factor and is linked to cardiovascular risk factors such as obesity, hypertension, type 2 diabetes, and dyslipidemia. Few previous studies have investigated whether NAFLD could be independently associated with cognitive impairment. The current study aims to find a possible role of NAFLD in the development of subcortical vascular dementia (sVaD). We considered NAFLD as a possible independent vascular risk factor or, considering its metabolic role, associated with other commonly accepted sVaD risk factors, i.e., lack of folate, vitamin B12, and vitamin D-OH25, and increased levels of homocysteine. We studied 319 patients diagnosed with sVaD. All patients underwent an abdominal ultrasound examination to classify steatosis into four levels (1—none up to 4—severe). sVaD patients were divided into two groups according to the presence or absence of NAFLD. Our results demonstrated a strong correlation between NAFLD and sVaD. Patients with the two comorbidities had worse neuropsychological outcomes and a worse metabolic profile. We also found a robust relationship between NAFLD and severe vitamin B12, folate, vitamin D hypovitaminosis, and higher hyperhomocysteinemia levels. This way, it is evident that NAFLD contributes to a more severe metabolic pathway. However, the strong relationship with the three parameters (B12, folate and vitamin D, and homocysteinemia) suggests that NAFLD can contribute to a proinflammatory condition.
... These findings are in agreement with previous studies. 5,13,23 Antonysunil et al 5 reported vitamin B12 deficiency was inversely correlated with cholesterol, triglycerides and cholesterol/ HDL ratio in type 2 diabetic subjects. The findings of above study are consistent with the present study. ...
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Objective: To determine the vitamin B12 deficiency and dyslipidemia in Gestational Diabetes mellitus (GDM) diagnosed pregnant women. Study Design: Observational study. Setting: Department of Biochemistry and Gynecology/Obstetrics LUMHS Hospital Jamshoro. Period: January 2018 to December 2018. Material & Methods: A sample of 216 diagnosed GDM pregnant women was selected according to study criteria. Venous blood samples were centrifuged to separate sera; that were used for the estimation of (hexokinase method), blood lipids and Vitamin B12 (ECLIA assay method) by Cobas chemistry analyzer. Statistical SPSS software 21.0 (IBM, Inc USA) was used for study research variables at 95% CI (P ≤ 0.05). Results: Age of GDM cases was 36.12±9.5 years. Mean+/-SD vitamin B12 level was noted 154.7±81.7 ng/mL (P=0.0001). Serum cholesterol, triglycerides and LDLc were elevated and HDLc was low in GDM cases (P=0.0001). Of 216 GDM cases, vitamin B12 deficiency was present in 152 (70.3%) (P=0.0001) and dyslipidemia in 50 (23.1%) (X2=452.0) (P=0.0001). Vitamin B12 shows inverse correlation with RBG (r= -0.41, P=0.005), CHOL (r= -0.25, P=0.024), TAG (r= -0.81, P=0.0001), LDLc (r= -0.797, P=0.0001) and positive correlation with HDLc (r= 0.76, P=0.0001). Conclusion: The present study finds vitamin B12 deficiency in 152 (70.3%) and dyslipidemia in 50 (23.1%). Vitamin B12 deficient GDM women show high cholesterol, triglycerides, LDLc and low HDLc. Hence, it is concluded, the vitamin B12 deficiency is linked with dyslipidemia in Gestational Diabetes mellitus.
Objetivo: Caracterizar uma amostra quanto as dosagens das vitaminas D e B12 e a associação desses valores com os de colesterol total (CT) e frações (HDL-C e LDL-C). Métodos: Estudo transversal, de caráter piloto, realizado a partir de dados coletados em abril/2019 em um laboratório de análises clínicas privado na cidade de Juiz de Fora/MG. Foram incluídos indivíduos ≥18 anos, de ambos os sexos e que fizeram os exames analisados em uma única coleta. Resultados: A amostra (n=217) foi predominantemente formada por mulheres (71,4%) e idosos (53,9%). A prevalência de hipovitaminose D foi de 12,4% e de B12, 18,5%. Quanto ao HDL-C, apenas 5,53% apresentavam valores inferiores ao recomendado, já LDL-C e CT, 61,75% e 57,6% da amostra, respectivamente, estavam acima dos valores de referência. A partir da avaliação da amostra e corroborando achados de outros estudos sobre a temática, verificou-se correlação forte e moderada, respectivamente, entre os valores de vitamina D e CT e LDL-C. Conclusão: Além de a amostra ter apresentado a necessidade de adequação dos valores de vitamina B12, CT e LDL-C, os valores de vitamina D parecem desempenhar um papel benéfico nas taxas de CT e LDL, podendo ser um alvo importante na Medicina Preventiva.
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This cross‐sectional study aimed to profile 15 genetic markers associated with the risks of nutrient deficiencies and eating disinhibition behaviors that could lead to obesity among the Orang Asli (OA) and the Malays. The whole‐genome sequences of 98 OA and 96 Malay individuals were mined for these 15 genetic variants. The distributions of risk allele frequencies were then compared with other world populations to determine the impact of these genetic variations on the wellness of the two cohorts. The risk alleles include rs2025804 G, rs1800497 T, rs4680 G, rs602662 G, rs174547 C, and rs4654748 C, were commonly found among the OA and Malays and are likely to be pathogenic genetics variants for obesity. The risk allele frequencies differed significantly between the studied and the other five populations (p < .05). We believe that this is the first reported study on the genetic variants associated with nutrient deficiencies and eating disinhibition behaviors that are likely to increase risks of obesity among the OA and Malays. Toward precision nutrition: Genetic risks of nutrients deficiencies and eating behaviors among the Orang Asli and Malays.
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Aim: To investigate the correlation between vitamin B12 and body mass index (BMI) along with insulin resistance (IR) in middle-aged obese women. Materials and methods: The study was designed as a case-control study. The study group included middle-aged obese women and the control group included aged-matched lean women. Weight, height, and hip and waist circumferences were measured. Biochemical parameters such as fasting and postprandial glucose, vitamin B12 and folic acid levels, and lipid profiles were assayed. Results: Enrolled in the study were 116 middle-aged obese and 103 aged-matched healthy lean women. The vitamin B12 level of the obese women was significantly lower than that of the lean women (244.1 ± 131.5 pg/mL vs. 336.2 ± 163.1 pg/mL, P = 0.002). However, there was no significant difference in folic acid levels between the groups (P > 0.05). The vitamin B12 level was similar in the obese women with metabolic syndrome and those without (245.1 ± 145.3 pg/mL vs. 241.2 ± 96.5 pg/mL, P > 0.05), but the level in the control group was significantly higher than that of patients with obesity and metabolic syndrome (P = 0.010 and P = 0.020, respectively). Vitamin B12 levels correlated with BMI (r = -0.259, P = 0.003) but not with IR (r = -0.053, P > 0.05). Conclusion: The vitamin B12 concentration was low in obese patients and this level negatively correlated with BMI, but not with homeostasis model assessment-estimated IR (HOMA-IR).
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Background—Rising body weight is a major public health concern. However there have been few worldwide comparative analyses of long-term trends of body mass index (BMI), and none that have used recent national health examination surveys.Methods—We estimated trends in mean in BMI and their uncertainties for adults 20 years of age and older in 199 countries and territories. Data were from published and unpublished health examination surveys and epidemiologic studies. For each sex, we used a Bayesian hierarchical model to estimate BMI by age, country, and year, accounting for whether a given study was nationally representative.Findings—Between 1980 and 2008, global mean BMI increased at an annualized rate of 0.4 (95% uncertainty interval 0.2, 0.6, posterior probability (PP) of being a true increase > 0.999) kg/m2/decade for men and 0.5 (0.3–0.7, PP > 0.999) for women. National BMI change for women ranged from non-significant declines in 19 countries to rising over 2.5 (PP > 0.999) kg/m2/decade in Tonga and Cook Islands. There was an increase in male BMI in all but a few countries, reaching over 2 kg/m2/decade in Nauru and Cook Islands, PP > 0.999. Male and female BMIs in 2008 were highest in some Oceania countries, reaching 33.9 (32.8, 35.0) kg/m2 (men) and 35.0 (33.6, 36.3) (women) in Nauru. Female BMI was lowest in Bangladesh (20.5; 19.8, 21.3) kg/m2 and male BMI in Democratic Republic of the Congo 19.9 (18.2, 21.5), with BMI also below 21.5 kg/m2 for both sexes in a few countries in sub-Saharan Africa, and East, South, and Southeast Asia. USA had the highest BMI among high-income countries, followed by New Zealand. In 2008, an estimated 1.47 billion adults worldwide had BMI ≥ 25 kg/m2; of these 205 (193, 217) million men and 297 (280, 315) million women were obese.Interpretation—Globally, mean BMI increased since 1980. The trends since 1980, and mean population BMI in 2008, varied substantially across nations. Interventions and policies that can curb or reverse the increase, and mitigate the health effects of high BMI by targeting its metabolic mediators, are needed in most countries. (PDF) 4. Finucane MM, Ezzati M et al., Kusuma YS – Global Burden of Metabolic Risk Factors of Chronic Diseases Collaborating Group (Body Mass Index) (2011). National, regional, and global trends in body-mass index since 1980: systematic analysis of health examination surveys and epidemiological studies with 960 country-years and 9•1 million participants. Lancet 377: 557–567.. Available from: [accessed Mar 17 2021].
Obesity has reached epidemic proportions in the United States: more than 20% of adults are clinically obese as defined by a body mass index of 30 kg/m 2 or higher, and an additional 30% are overweight. Environmental, behavioral, and genetic factors have been shown to contribute to the development of obesity. Elevated body mass index, particularly caused by abdominal or upper-body obesity, has been associated with a number of diseases and metabolic abnormalities, many of which have high morbidity and mortality. These include hyperinsulinemia, insulin resistance, type 2 diabetes, hypertension, dyslipidemia, coronary heart disease, gallbladder disease, and certain malignancies. This underscores the importance of identifying people at risk for obesity and its related disease states.
Obesity has become a major concern among gastroenterologists due to its large influence on gastrointestinal and hepatic diseases: reflux esophagitis, pancreatitis, gallstone disease, liver fibrosis, and neoplastic tumors of the esophagus, pancreas, and colon. Studies of morbid obese subjects undergoing bariatric surgery have revealed that obesity is related with an increased prevalence of endoscopic and histologic gastritis. A recent study of health check-up subjects demonstrated an association of obesity with endoscopic gastritis and gastric ulcers. We recently investigated the underlying mechanisms of the effects of obesity on endoscopic gastritis in subjects undergoing health check-up examination, and demonstrated that adiponectin, a bioactive molecule released from visceral fat, could be a protective factor of endoscopic gastritis. We would like to propose a new category of gastritis, obesity-related gastritis, which could become dominant in the near future.
Rising prevalence of obesity is a worldwide health concern because excess weight gain within populations forecasts an increased burden from several diseases, most notably cardiovascular diseases, diabetes, and cancers. In this report, we used a simulation model to project the probable health and economic consequences in the next two decades from a continued rise in obesity in two ageing populations--the USA and the UK. These trends project 65 million more obese adults in the USA and 11 million more obese adults in the UK by 2030, consequently accruing an additional 6-8·5 million cases of diabetes, 5·7-7·3 million cases of heart disease and stroke, 492,000-669,000 additional cases of cancer, and 26-55 million quality-adjusted life years forgone for USA and UK combined. The combined medical costs associated with treatment of these preventable diseases are estimated to increase by $48-66 billion/year in the USA and by £1·9-2 billion/year in the UK by 2030. Hence, effective policies to promote healthier weight also have economic benefits.
This study performed to determine the effects of folate supplementation on indices of glycemic control, insulin resistance and lipid profile in overweight and obese men with type 2 diabetes under metformin (at least 1500 mg daily) treatment. The study was a double-blind randomized controlled clinical trial. Forty-eight overweight and obese men (aged 58.2±8.9 years; BMI=28.6±2.9 kg/m(2)) with type 2 diabetes participated in the study. Patients were divided randomly into two groups of folic acid (5 mg/d) and placebo. All patients received the tablets for eight weeks. Supplementation with folic acid led to 8% decrease in HbA1C (p=0.048), 7.5% in fasting blood glucose (p=0.051), 16.2% in serum insulin (p=0.021), 20.5% in insulin resistance (p=0.041) and 21.2% in plasma homocysteine (p=0.000). A significant increase in serum folate and B12 levels (19% and 17.3%, p=0.000, respectively) were observed in the folic acid group, whereas no significant changes occurred in the placebo group. Also, in the folic acid and placebo groups, there were no significant changes in body weight. Folic acid supplementation lowered plasma level of homocysteine, improved glycemic control and insulin resistance in patients with type 2 diabetes.
Aim: In this study, it was aimed to compare the sociodemographic features and biochemical parameters of the patients with Metabolic Syndrome (MS) and Type 2 Diabetes Mellitus (DM) with control group.Material and Method: In this study, among the patients who applied to Dicle University Faculty of Medicine Family Practice outpatient policlinic, 32 patients with MS, 21 patients with Type 2 DM were taken and 21 patients were selected for control group. Patients with MS and Type 2 DM were compared with control group according to their sociodemographic, anthropometric and biochemical parameters.Results: Of 74 patients applied to the study, 29 were female and 45 were male. There weren’t any statistical differences about gender, education, diet and exercise between the three groups (respectively, p=0,224, p=0,216, p=0,234 and p=0,504). W/H ratios, BMI and ages were statistically meaningful between three groups (respectively p=0,001, p=0,005 and p=0,0001). Patients with MS had higher W/H ratios and BMI values. HOMA-IR values were increasing with age (r=0,295, p=0,011), also there was a positive correlation between HOMA-IR and T.CHOL/HDL ratios (r=0.296, p=0.010).Conclusion: While HOMA-IR values were significantly higher in Type 2 DM group, any differences between MS and control group were not detected. Also in both two study groups, HOMA-IR values were increasing with age and there was a positive correlation between HOMA-IR and T.CHOL/HDL ratios. BMI values were positively correlated with systolic and diastolic blood pressures and also W/h ratios. TG values were increasing with W/H ratios.