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Association between dietary vitamin B12 intake and bone mineral density in adolescents

Pediatric Research (2025)Cite this article

Abstract

Background

Vitamin B12, essential for bone health, has an unclear relationship with bone mineral density (BMD) in adolescents. This study examined this association.

Methods

Data were drawn from the National Health and Nutrition Examination Survey (NHANES). Dietary vitamin B12 intake was assessed via 24-hour dietary recall, and BMD at the lumbar spine and femur was measured using dual-energy X-ray absorptiometry (DXA). Multiple regression models were employed to assess the relationship between vitamin B12 intake and BMD, adjusting for confounders. Subgroup analyses and interaction tests were performed, followed by sensitivity analyses, including multiple imputation for missing covariates data.

Results

Among 2531 adolescents aged 12–19, higher dietary vitamin B12 intake was associated with greater BMD at both the lumbar spine and femur. A 5 mcg/day increase in vitamin B12 intake corresponded to a 12.60 mg/cm² increase in lumbar spine BMD (P = 0.009) and a 20.08 mg/cm² increase in femoral BMD (P = 0.001). Participants in the highest tertile of intake had significantly higher BMD than those in the lowest tertile. Subgroup and sensitivity analyses showed consistent results.

Conclusions

Higher vitamin B12 intake may support better BMD in adolescents, but further studies are needed to confirm these findings.

Impact

  • Higher dietary vitamin B12 intake may support bone health in adolescents during a critical growth phase.

  • This study provides new evidence linking vitamin B12 intake with bone mineral density in a large, nationally representative cohort.

  • The findings highlight the potential need for targeted nutritional strategies to optimize adolescent bone health.

  • Future research should confirm these results and explore sex- and age-specific differences.

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Fig. 1: Flowchart of study design.
Fig. 2: The relationship between vitamin B12 intake and bone mineral density in different subgroups.

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Data availability

The data utilized in this study were obtained from the NHANES, a publicly available dataset provided by the CDC. The data can be accessed freely at https://www.cdc.gov/nchs/nhanes/index.htm. All relevant data supporting the findings of this study are available within the NHANES database.

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Acknowledgements

We gratefully acknowledge the contributions of Jie Liu from the Department of Vascular and Endovascular Surgery at the Chinese PLA General Hospital and Qilin Yang from the Second Affiliated Hospital of Guangzhou Medical University. Their statistical support, study design consultations, and comments on the manuscript were invaluable.

Author information

Author notes

  1. These authors contributed equally: Keyi Li, Chunhong Guo.

Authors and Affiliations

  1. Department of Radiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang Province, China

    Keyi Li

  2. The Second Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China

    Chunhong Guo

  3. Division of Spine Center, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China

    Chunhong Guo

  4. Department of Orthopedics, The Armed Police Forces Hospital of Shandong, Jinan, Shandong Province, China

    Yishan Yin

  5. Department of Operating Room, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China

    Xiaojun Chen

  6. Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning Province, China

    Mingxuan Zheng

  7. Department of Orthopedics, Liaoning University of Traditional Chinese Medicine Affiliated Hospital, Shenyang, Liaoning Province, China

    Mingxuan Zheng

Authors
  1. Keyi Li
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  2. Chunhong Guo
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  3. Yishan Yin
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Contributions

Keyi Li: Writing – Conceptualization, original draft, Software, Resources, Project administration, Methodology, Investigation, Formal analysis, Data curation. Chunhong Guo: Writing – review & editing, Methodology, Investigation. YiShan Yin: Writing – review & editing, Supervision. Xiaojun Chen: Writing – review & editing, Supervision. Mingxuan Zheng: Conceptualization, Methodology, Writing – original draft, Software, Investigation, Data curation. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Mingxuan Zheng.

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Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

This study utilized publicly available data from the NHANES, which is conducted by the CDC. NHANES received approval from the National Center for Health Statistics (NCHS) Research Ethics Review Board, and informed consent was obtained from all participants or their guardians. No additional ethical approval was required for this secondary analysis, as the data were fully anonymized and de-identified prior to access.

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Li, K., Guo, C., Yin, Y. et al. Association between dietary vitamin B12 intake and bone mineral density in adolescents. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04150-6

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  • DOI: https://doi.org/10.1038/s41390-025-04150-6

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