Foods and Supplements Associated with Vitamin B12 Biomarkers among Vegetarian and Non-Vegetarian Participants of the Adventist Health Study-2 (AHS-2) Calibration Study

To investigate the association between plasma concentration of vitamin B12 and B12 intake from supplements, fortified foods, and animal source foods among vegetarians and non-vegetarians, we conducted a cross-sectional analysis among 728 participants of the Adventist Health Study 2 (AHS-2) calibration study. The median age of participants was 58 years, 65.4% were female, and 50.3% were White. We used six 24 h dietary recalls to measure B12 intake, serum vitamin B12, and holotranscobalamin (holoTC) concentration. B12 supplements had a significantly positive association with plasma B12 among all subjects (p trend < 0.001), especially among vegans and lacto-ovo vegetarians (p trend < 0.001). Among non-users of B12 supplements, B12 intake from milk substitutes was significantly positively associated with holoTC (p trend < 0.004) and serum B12 (p trend < 0.030). In non-vegetarians, holoTC was significantly positively associated with B12 intake from eggs, while serum B12 was significantly positively associated with B12 intake from milk in the upper tertile compared to the lower, and B12 intake from meat in the middle compared to the lower tertile intake (p < 0.011). Supplements containing B12 followed by B12 intake from milk substitutes were significant contributors of plasma vitamin B12 concentration