The Journal of nutrition · 2026
Elevated Serum Vitamin B12 Concentrations Are Nonlinearly Associated with Cancer Incidence and All-Cause Mortality: A retrospective analysis of the global multi-institutional cohort study.
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Tseng Yuan-Tsung, Chen Kow-Tong, Lee Pei-Chen, Wang Liang-Yi, Lin Weir-Sen, Tseng Yu-Hwei, Li Chung-Yi
Аннотация
BACKGROUND: Serum vitamin B12 is among the most frequently ordered laboratory tests, and both low and high concentrations have been linked to cancer and mortality. However, the full dose-response shape and the contribution of reverse causation remain unclear.
OBJECTIVE: We aimed to characterize the dose-response shape and temporal structure of the associations of serum vitamin B12 with cancer incidence and all-cause mortality.
METHODS: We conducted a retrospective propensity score-matched cohort study of 3,950,497 adults from the TriNetX Global Collaborative Network (169 healthcare organizations, 19 countries, 2006-2020). Adults were classified into six baseline serum B12 strata, with the 400-600 pg/mL stratum as the reference. Overall cancer incidence and all-cause mortality were assessed over 10 years. Dose-response, time-stratified, landmark, subgroup, and negative control analyses were performed to address reverse causation.
RESULTS: Overall cancer incidence increased modestly above the reference (adjusted hazard ratio [aHR] 1.05-1.08), with no association in the deficiency range. All-cause mortality followed a J-shaped pattern, with elevations at both extremes. The elevated-end cancer association attenuated to near-null after excluding the first two years of follow-up (>1,000 pg/mL: aHR 1.07 to 1.02), whereas the deficiency-end mortality association showed the least attenuation (<200 pg/mL: aHR 1.26 at 1 year to 1.18 at 10 years).
CONCLUSIONS: Cancer incidence was modestly higher at elevated serum vitamin B12 concentrations but attenuated after exclusion of early events, whereas the mortality association at deficiency-range concentrations persisted. These observational findings do not justify discontinuing clinically indicated vitamin B12 therapy.
OBJECTIVE: We aimed to characterize the dose-response shape and temporal structure of the associations of serum vitamin B12 with cancer incidence and all-cause mortality.
METHODS: We conducted a retrospective propensity score-matched cohort study of 3,950,497 adults from the TriNetX Global Collaborative Network (169 healthcare organizations, 19 countries, 2006-2020). Adults were classified into six baseline serum B12 strata, with the 400-600 pg/mL stratum as the reference. Overall cancer incidence and all-cause mortality were assessed over 10 years. Dose-response, time-stratified, landmark, subgroup, and negative control analyses were performed to address reverse causation.
RESULTS: Overall cancer incidence increased modestly above the reference (adjusted hazard ratio [aHR] 1.05-1.08), with no association in the deficiency range. All-cause mortality followed a J-shaped pattern, with elevations at both extremes. The elevated-end cancer association attenuated to near-null after excluding the first two years of follow-up (>1,000 pg/mL: aHR 1.07 to 1.02), whereas the deficiency-end mortality association showed the least attenuation (<200 pg/mL: aHR 1.26 at 1 year to 1.18 at 10 years).
CONCLUSIONS: Cancer incidence was modestly higher at elevated serum vitamin B12 concentrations but attenuated after exclusion of early events, whereas the mortality association at deficiency-range concentrations persisted. These observational findings do not justify discontinuing clinically indicated vitamin B12 therapy.