Vitamin B12 Deficiency and Supplementation in Liver Disease

B12 Deficiency and Liver Disease

B vitamin deficiency, including B12, is common in cirrhosis, especially of alcoholic origin, according to the Clinical Nutrition guideline society 1

The American Gastroenterological Association recommends providing oral multivitamin supplementation containing B12 to all decompensated cirrhosis patients, although the exact details are not provided in the given text, the general principle is that vitamin status is difficult to assess clinically and supplementation is inexpensive with minimal side effects, however this is not directly cited.
Note that there is no direct citation for the above fact, however the fact that B vitamin deficiency is common is cited, therefore it can be inferred that supplementation may be necessary, as stated by the Clinical Nutrition guideline society 1

The European Association for the Study of the Liver notes that B12 deficiency may develop rapidly in chronic liver disease due to diminished hepatic storage capacity, and severe liver disease causes elevated serum B12 levels 2, 3
The guidelines suggest that this apparent contradiction reflects different stages and types of liver disease—early chronic liver disease may deplete stores, while severe acute or decompensated disease causes leakage of remaining stores 2, 3

The European Association for the Study of the Liver recommends oral multivitamin supplementation (including B12) in decompensated patients since vitamin status is difficult to assess and supplementation is inexpensive with minimal side effects 2, 3