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Correlation of vitamin B12 level with insulin resistance in infant and placenta outcomes
Mutmainna Kamaruddina, Elizabet Jusufb,
Corresponding author
elizabeth@pasca.unhas.ac.id

Corresponding author.
, Himawan Sanusic
a Department of Midwifery, Graduate School, Hasanuddin University, Indonesia
b Department of Obstetrics and Gynecology, Faculty of Medicine, Hasanuddin University, Indonesia
c Department of Internal Medicine, Faculty of Medicine, Hasanuddin University, Indonesia
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The needs of a maternal woman during pregnancy for food elements&#44; such as iron&#44; vitamin C&#44; folic acid&#44; and protein are increasing&#46; If these needs are not fulfilled&#44; the mother will get anemia&#46; A common cause of anemia is lack of nutrients &#8211; protein&#44; iron&#44; pyridoxine &#40;vitamin B6&#41;&#44; vitamin B12&#44; vitamin C&#44; folic acid&#44; and vitamin E &#8211; that play a role in the formation of hemoglobin&#44; either due to lack of consumption or due to absorption disorders&#46; Vitamin B12 is needed to activate folic acid in the normal function of the metabolism of all cells&#44; especially digestive cells&#44; marrow bone&#44; and nerve tissue&#46; Folic acid plays a role in the metabolism of amino acids needed in the formation of red blood cells&#44; white blood cells&#44; and their maturation&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Lack of vitamin B12 and folic acid during pregnancy is related to an increased risk of preterm birth&#44; low birth weight&#44; and disruption of fetal growth&#46; Mothers who get adequate folic acid supplementation will increase body weight&#44; decrease the incidence of mental retardation and maternal infections&#44; in contrast to mothers with levels folic acid less than 240<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;dl the risk of giving birth to an LBW and premature baby increases by more than 200&#37;&#46; In addition&#44; folic acid with a significant requirement of 600<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;day will affect brain growth by 70&#37; compared to other nutrients&#46; Sources of vitamin B12 can be obtained from meat&#44; tuna&#44; eggs&#44; milk&#44; cheese&#44; and shellfish&#44; while folic acid can be obtained from green vegetables&#44; fruits&#44; cereals&#44; nuts&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Several studies report that a woman who is deficient in vitamin B12 increases the occurrence of insulin resistance and Major depressive disorder &#40;abbreviated as GDM&#41;&#46; Vitamin B12 deficiency in a maternal woman is associated with increased adiposity&#44; and ultimately&#44; an increase of insulin resistance and Major depressive disorder &#40;abbreviated as GDM&#41; occurs&#46; This study also states that vitamin B12 deficiency may be an important factor underlying the high risk of diabetes in South Asia&#44; India&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">One of the changes that occur in a healthy woman&#39;s pregnancy is the resistance of insulin during uptake and glucose utilization&#46; During early pregnancy&#44; normal glucose tolerance increases slightly&#44; and peripheral &#40;muscle&#41; sensitivity to insulin and normal hepatic basal glucose production due to increased maternal estrogen and progesterone hormones in early pregnancy increases pancreatic &#946; cell hyperplasia&#44; so this causes an increase of insulin release&#46; It explains an increase of insulin in early pregnancy is a response to insulin resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">During pregnancy&#44; the body&#39;s insulin resistance increases three-fold compared to nonpregnancy&#46; In pregnancy&#44; decreased insulin sensitivity is characterized by post-receptor defects that reduce insulin&#39;s ability to mobilize SLC2A4 &#40;GLUT 4&#41; from the cell to the cell surface&#46; This might be caused by an increase in hormone-related to pregnancy&#46; Although pregnancy is associated with a rise in &#946; cell mass and an increase of insulin levels&#44; some women cannot increase their insulin production relative to an increase of insulin resistance&#44; thus becoming hyperglycemic and suffering Gestational Diabetes Mellitus &#40;abbreviated as DMG&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Insulin resistance affects other metabolic that can cause overgrowth in the fetus&#46; Besides&#44; the anabolic effect of hyperinsulinemia that characterizes insulin resistance might also explain the increase in fetal growth&#46; Several studies have reported that insulin resistance might be related to adverse pregnancy outcomes including an increase of insulin resistance and an increase of macrosomia risk&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">5&#8211;7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Based on this statement&#44; this study aims to assess the correlation of Vitamin B12 and Insulin Resistance toward the outcome of infant and placenta&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Method</span><p id="par0040" class="elsevierStylePara elsevierViewall">This research was conducted in the working area of Mother and Child hospital &#40;abbreviated as RSIA&#41; Sitti Khadijah 1 Makassar from March to May 2019&#46; The population in this study were pregnant women in Khadijah Makassar Hospital&#46; The study subject was total sampling&#44; and the criteria of the sample in the study were second trimester and third-trimester pregnant women&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In this study&#44; data from physical examination results and laboratory samples were recorded and collected&#46; The physical examination carried out in the maternal and child health &#40;abbreviated as MCH&#41; room&#46; Blood samples were taken by laboratory staff at RSIA Khadijah 1 Makassar then&#44; blood samples were taken and examined at the laboratory of Hasanuddin University&#46; Pregnant women who were respondents were monitored until birth&#59; then&#44; the examination of the baby&#39;s weight and placental weight after the baby was born using a scale was carried out&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Results</span><p id="par0050" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows that from 87 respondents &#40;100&#37;&#41;&#44; respondents in Vitamin B12 category&#44; high vitamin B12 levels are 22 respondents &#40;25&#46;3&#37;&#41;&#46; While respondents with low levels of vitamin B12 are 65 respondents &#40;74&#46;7&#37;&#41;&#46; Based on the characteristics of the HOMA IR&#44; it shows that out of 87 respondents &#40;100&#37;&#41;&#44; respondents who are resistant are 29 respondents &#40;53&#46;3&#37;&#41;&#46; Whereas non-resistance respondents are 58 respondents &#40;66&#46;7&#37;&#41;&#46; Based on the characteristics of Infant Weight shows that from 87 respondents &#40;100&#37;&#41;&#44; respondents with normal weight category are 71 respondents &#40;81&#46;6&#37;&#41;&#46; While LBW respondents are 16 respondents &#40;18&#46;4&#37;&#41;&#46; Based on educational characteristics shows that from 87 respondents &#40;100&#37;&#41;&#44; respondents with normal placental weight categories are 71 respondents &#40;81&#46;6&#37;&#41;&#46; While respondents with abnormal placental weight are 16 respondents &#40;18&#46;4&#37;&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows that from 22 respondents who experience high vitamin B12 7 respondents &#40;31&#46;8&#37;&#41; experience insulin resistance&#44; and 15 respondents &#40;68&#46;2&#37;&#41; do not experience insulin resistance&#46; While 65 respondents who experienced low vitamin B12 22 respondents &#40;33&#46;8&#37;&#41; experience insulin resistance and 43 respondents &#40;66&#46;2&#37;&#41; do not experience insulin resistance&#46; After doing statistical tests using the Chi-Square test&#44; <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;862 means it is higher than &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; It shows that there is no significant correlation of vitamin B12 with insulin resistance in the working area of RSIA Sitti Khadijah 1 Makassar&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows from 22 respondents who experienced high vitamin B12&#44; 15 respondents &#40;68&#46;2&#37;&#41; experience normal infant weight and seven respondents &#40;31&#46;8&#37;&#41; experience LBW&#46; As many as 65 respondents who experienced low vitamin B12&#44; 56 respondents &#40;86&#46;2&#37;&#41; experience normal infant weight and nine respondents &#40;13&#46;8&#37;&#41; experience LBW&#46; From 22 respondents who experienced high vitamin B12&#44; 15 respondents &#40;68&#46;2&#37;&#41; experience normal placental weight&#44; and seven respondents &#40;31&#46;8&#37;&#41; experience abnormal placental weight&#46; And from 65 respondents who experienced low vitamin B12&#44; 56 respondents &#40;86&#46;2&#37;&#41; have normal placental weight&#44; and nine respondents &#40;13&#46;8&#37;&#41; have abnormal placental weight&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">After doing a statistical test using <span class="elsevierStyleItalic">Chi-Square</span> test&#44; <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;107 means greater than &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; It shows that there is no significant correlation between Vitamin B12 and infant weight&#46; And <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;107 means greater than &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; It shows that there is no significant correlation between Vitamin B12 and placenta weight in pregnancy in the work area of RSIA Sitti Khadijah 1 Makassar&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows that from 29 respondents who experienced insulin resistance&#44; 24 respondents &#40;82&#46;8&#37;&#41; experience normal infant weight&#44; and five respondents &#40;17&#46;2&#37;&#41; experience LBW&#46; From 58 respondents who are not insulin resistant&#44; 47 respondents &#40;81&#46;0&#37;&#41; who experience normal infant weight and 11 respondents &#40;19&#46;0&#37;&#41; experience LBW&#46; Of 29 respondents who experienced insulin resistance&#44; 24 respondents &#40;82&#46;8&#37;&#41; experience normal placental weight and five respondents &#40;17&#46;2&#37;&#41; experience abnormal placental weight&#46; And 58 respondents who are not insulin resistant&#44; 47 respondents &#40;81&#46;0&#37;&#41; experience normal placental weight&#44; and 11 respondents &#40;19&#46;0&#37;&#41; experience abnormal placental weight&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">After doing a statistical test using the Chi-Square test&#44; <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;845 means greater than &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; It shows that there is no significant correlation of insulin resistance with infant weight&#46; And <span class="elsevierStyleItalic">p</span>-value<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;854 means greater than &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; It shows that there is no significant correlation of insulin resistance with placental weight in the working area of the RSIA Sitti Khadijah 1 Makassar&#46; <a class="elsevierStyleCrossRef" href="#tbl0025">Table 5</a>&#44; by using the Spearman test shows that none of the 87 study samples correlates with Vitamin B12&#46;</p><elsevierMultimedia ident="tbl0025"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Discussion</span><p id="par0080" class="elsevierStylePara elsevierViewall">In this study&#44; we have found that the average of pregnant women who experience vitamin B12 deficiency is 65&#37;&#46; We have found that there is no significant correlation between vitamin B12 and insulin resistance&#46; It may be the existence of an additional mechanism&#44; and other factors linking vitamin B12 to insulin resistance&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">This study is in line with research that states that there is no significant correlation of vitamin B12 with Insulin Resistance&#46; The high level of obesity observed may have overshadowed other factors that contribute to insulin resistance&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0090" class="elsevierStylePara elsevierViewall">Although in previous studies&#44; it has been confirmed that vitamin B12 levels correlates with low birth weight and preterm labor but according to Ronnenberg et al&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> the correlation is determined by adequate folate intake&#46; Low folate at 28 weeks causes the risk of premature birth and low birth weight highly&#46; Although vitamin B12 deficiency is not related to poor obstetric outcomes&#44; a positive correlation is found between maternal vitamin B6 and infant birth weight&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">In this study&#44; only a small proportion is overweight&#46; Seeing from the weight status before pregnancy&#44; the average body weight is normal&#46; We argue that&#44; in this study&#44; there are no significant results between insulin resistance and maternal outcomes&#44; which might be due to maternal body mass index before pregnancy and excessive pregnancy weight gain related to an infant weight&#46; Mothers who give birth with excess birth weight may also be caused by factors due to a history of diabetes mellitus &#40;abbreviated as DM&#41; except insulin resistance itself&#46; Our suspicion is reinforced with Sofian&#39;s opinion that states the danger of excess weight gain in pregnant women causes large babies and it can complicate labor&#46; After that&#44; it can be a symptom of diabetes mellitus in pregnant women&#46; Besides&#44; we also argue that maternal genetic factors may also specifically affect the growth of the baby&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">In this study&#44; most respondents experience low levels of vitamin B12&#46; The decrease in low vitamin B12 levels is also thought to be related to slow vitamin B12 supplementation in pregnancy and non-compliance of respondents in taking supplements&#46; The results of previous studies state that a low level of vitamin B12 has high insulin resistance and affects the weight of the baby and placenta&#46; But the results of the review and analysis of this study&#44; we do not find a significant correlation of vitamin B12 level with insulin resistance and its effect on the outcome of infant and placenta weight&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">The incompatibility of this study with previous research might be due to factors from different races&#44; and the criteria in the selection of research samples&#46; The birth weight of a baby depends on the nutrition of the mother and the ability of the placenta to transport nutrients from the mother to her fetus&#46; The placental weight and the size and shape of its surface reflect its ability to transfer nutrients&#46; The mother&#39;s weight has a greater effect on the baby&#39;s birth weight than the mother&#39;s height&#46; The weight of the mother before and during pregnancy greatly influences the outcome of the pregnancy&#46; Women who are underweight before pregnancy tend to give birth faster &#40;prematurely&#41; and give birth to Low Birth Weight Babies &#40;LBW&#41;&#46; A mother&#39;s weight gain during pregnancy is directly related to her baby&#39;s weight&#44; and the risk of giving birth to LBW increases with the lack of weight gain during pregnancy&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p><p id="par0110" class="elsevierStylePara elsevierViewall">The placental weight reflects placental development and function and correlates with maternal age&#44; gestational age&#44; an increase of weight gain during pregnancy&#44; BMI&#44; MUAC&#46; The placenta plays an important role in normal fetal development&#44; and the failure of the placenta to gain weight and function insufficiency can result in fetal disorders&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusion</span><p id="par0115" class="elsevierStylePara elsevierViewall">From the results of research conducted by researchers&#44; it can be concluded that&#59; Vitamin B12 does not correlate with insulin resistance&#59; Vitamin B12 does not correlate with infant and placental outcomes&#59; Insulin resistance does not correlate with infant and placental outcomes&#46; &#40;4&#41; The average level of vitamin B12 is low in normal pregnancy&#59; Low levels of vitamin B12 are common in trimester II and III pregnant women&#46; Better nutritional intake and compliance in taking vitamins need to be considered in order to avoid vitamin B12 deficiency and it is hoped for further and more in-depth research especially in the selection of research samples in different regions&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conflict of interest</span><p id="par0120" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
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          "identificador" => "xres1899076"
          "titulo" => "Abstract"
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          "titulo" => "Introduction"
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          "identificador" => "sec0010"
          "titulo" => "Method"
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          "identificador" => "sec0030"
          "titulo" => "Conflict of interest"
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          "titulo" => "References"
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    "tienePdf" => true
    "fechaRecibido" => "2019-05-29"
    "fechaAceptado" => "2019-07-15"
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      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
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          "palabras" => array:4 [
            0 => "Vitamin B12"
            1 => "Insulin resistance"
            2 => "Infant weight"
            3 => "Placenta weight"
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    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">This study aims to assess the correlation of vitamin B12 level with insulin resistance toward the outcome of the baby and the placenta&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Method</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This study used a <span class="elsevierStyleItalic">prospective cohort</span> study design&#46; The total sampling was 87 people&#46; The samples were pregnant women the second trimester and the third trimester&#46; Data were analyzed using the Chi-Square test and the Spearman test&#46; Pregnant women who were respondents were monitored until birth&#59; then&#44; the examination of the baby&#39;s weight and placental weight after the baby was born using a scale was carried out&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The result of this study shows that there is no significant correlation between levels of vitamin B12 and insulin resistance &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;864&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; there is no significant correlation between vitamin B12 and infant weight &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;107&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; there is no significant correlation between vitamin B12 and placental weight &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;107&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; There is no significant correlation between insulin resistance and infant weight &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;845&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#44; and there is no significant correlation between insulin resistance and placental weight &#40;<span class="elsevierStyleItalic">&#961;</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;845&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">There is no correlation of vitamin B12 with insulin resistance toward the outcome of the baby and the placenta&#46;</p></span>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Resistance&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33&#46;3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col">Vitamin B12&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle">0&#46;107<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a></td><td class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="middle">0&#46;107<a class="elsevierStyleCrossRef" href="#tblfn0005">&#42;</a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Low&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">86&#46;2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="13" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Insulin resistance</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Resistance&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">82&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">0&#46;845</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">82&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " rowspan="2" align="left" valign="middle">0&#46;845&#42;</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Non resistance&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">81&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">19&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">58&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">81&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#46;019&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;864&#42;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#46;202&nbsp;\t\t\t\t\t\t\n
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