http://content.nejm.org/cgi/content/full/342/12/897

Correspondence

Volume 342:897-898 !rch 23" 2### $um%er 12

&lindness in ! 'trict Veg!n

 

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ore 0nform!tion- +u%ed Cit!tion(o the ditor: Veget!ri!ns !re !t ris for nutrition!l deficienc, if the, do not recei)e )it!minsupplement!tion. e report ! c!se of se)ere %il!ter!l optic neurop!th, in ! p!tient ho h!d %een! )eg!n for m!n, ,e!rs !nd ho did not t!e )it!min supplements. (he p!tient" ! 33-,e!r-oldm!n ho h!d st!rted ! strict )eget!ri!n diet !t the !ge of 2# ,e!rs" !s referred for e)!lu!tion ofprogressi)e )isu!l loss. 0mpro)ed he!lth !s the re!son for the diet" hich cont!ined no eggs"d!ir, products" fish" or other sources of !nim!l proteins. e did not smoe or use !lcohol" !nd hismedic!l histor, !s unrem!r!%le.

5!min!tion shoed se)ere %il!ter!l optic neurop!th, ith )er, poor )ision 6less th!n 2#/4## in%oth e,es" centr!l scotom!t!" d,schrom!topsi!" !nd !troph, of the optic diss. e found noe)idence of ! compression of the )isu!l p!th!, or of ! to5ic" infectious" or infl!mm!tor, c!useof the %lindness. itochondri!l-$* !n!l,sis shoed no mut!tion for e%ers heredit!r, opticneurop!th,. ;n neurologic e5!min!tion" there !s ! sensor, peripher!l neurop!th," confirmed %,electroph,siologic studies. (he cere%rospin!l fluid !s norm!l" including the opening pressure.(he rem!inder of the gener!l e5!min!tion shoed no !%norm!lities.

(he pl!sm! le)el of fol!te !s lo 6<.4 nmol per liter= norm!l r!nge" 7.< to 28" !s ere the le)elsof )it!min &1 64 nmol per liter= norm!l r!nge" > to 4# !nd )it!min &12 6114 pmol per liter= norm!lr!nge" 1<# to 72#. (here ere !lso deficiencies of )it!mins *" C" " !nd !nd ?inc !ndselenium" %ut pl!sm! le)els of iron" ferritin" )it!min &>" !nd nicotin!mide ere norm!l. (hep!tient h!d meg!lo%l!stic !nemi! 6hemoglo%in le)el" 1#.< g per liter= me!n corpuscul!r )olume"11# @m3" hich !s not due to pernicious !nemi! 6there ere no !ntiAp!riet!l-cell or !ntiAintrinsic-f!ctor !nti%odies" upper g!strointestin!l endoscop, shoed norm!l f indings" !nd multiple%iopsies shoed no g!stric !troph, or other c!uses of m!l!%sorption. *fter tre!tment ithintr!muscul!r )it!min &12 61### @g d!il, for one ee !nd or!l multi)it!min supplement!tion"the hemoglo%in le)el !s norm!l !nd the sensor, neurop!th, h!d dis!ppe!red" %ut there !s noreco)er, of )ision.

Vit!min &12 deficienc, in )eget!ri!ns m!, c!use neurologic distur%!nces.1"2 oreo)er"deficiencies of )it!mins &12 !nd &1 m!, %e responsi%le for optic neurop!th, !ssoci!ted ithnutrition!l f!ctors.3 *m%l,opi! !nd p!inful neurop!th, h!)e %een reported in c!ses of diet!r,depri)!tion in prisoners during orld !r 00" !nd more recentl," diet!r, f!ctors ere noted in theCu%!n epidemic of optic neurop!th,.4 (he optic neurop!th, in our p!tient !s !pp!rentl, rel!tedto deficiencies of )it!mins &12 !nd &1" %ut other !ssoci!ted deficiencies m!, h!)e h!d ! role.Vit!min supplement!tion is essenti!l in persons ho !dhere to ! strict )eget!ri!n diet" especi!ll,%ec!use )it!min deficiencies m!, c!use se)ere" irre)ersi%le optic neurop!th,.

 

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Geferences

  1. *shen!?i '" eit? G" V!rs!no 0" imouni . Vit!min &12 deficienc, due to ! strictl,)eget!ri!n diet in !dolescence. Clin +edi!tr 6+hil! 1987=2>:>>2->>3.

2. Gen!ult " Verstichel +" +louss!rd H+" Costil H. $europ!th, in to co%!l!min-deficient %re!st-fed inf!nts of )eget!ri!n mothers. uscle $er)e 1999=22:2<2-2<4. ICrossGefJIedlineJ  3. iller $G" $em!n $H. !lsh !nd o,ts clinic!l neuro-ophth!lmolog,. <th ed. Vol. 1.&!ltimore: illi!ms K ilins" 1998:>>3-79.  4. (he Cu%! $europ!th, ield 0n)estig!tion (e!m. pidemic optic neurop!th, in Cu%! -- clinic!lch!r!cteri?!tion !nd ris f!ctors. $ ngl H ed 199<=333:117>-1182. Iree ull (e5tJ