Fuzzy Modeling for Vitamin B12 Deficiency
Blood vitamin B12 levels are not representative for actual vitamin B12 status in tissue. Instead plasma methylmalonic acid (MMA) levels can be measured because MMA concentrations increase relatively early in the course of vitamin B12 deficiency. However,
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Information Systems, School of Industrial Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands [email protected] 2 Catharina Hospital, Clinical Chemistry, Michelangelaan 2, 5623 EJ Eindhoven, The Netherlands 3 Department of Biomedical Engineering, Eindhoven University of Technology, P.O. Box 513, 5600 MB Eindhoven, The Netherlands
Abstract. Blood vitamin B12 levels are not representative for actual vitamin B12 status in tissue. Instead plasma methylmalonic acid (MMA) levels can be measured because MMA concentrations increase relatively early in the course of vitamin B12 deficiency. However, MMA levels in plasma may also be increased due to renal failure. In this paper we estimate the influence of the kidney function on MMA levels in plasma by using fuzzy inference systems. Using this method diagnosing vitamin B12 deficiencies could be improved when kidney failure is present.
Keywords: Vitamin B12 deficiency fuzzy inference system
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· Kidney function · Takagi-Sugono
Introduction
A deficiency in vitamin B12 is a common disorder which can result in various hematological and neurological disorders. Until a significant vitamin B12 deficiency is developed in the tissue, patients often remain asymptomatic. In the detection of vitamin B12 deficiency, measuring vitamin B12 levels in serum is not a proper representation of actual vitamin B12 levels in tissue [9,11]. As an indirect but functional measure of tissue vitamin B12 status, methylmalonic acid (MMA) levels in plasma can be measured as MMA concentrations increase relatively early in the course of vitamin B12 deficiency [2,5]. Vitamin B12 serves as a cofactor in the enzymatic reaction where the coenzyme A-linked form of MMA, i.e. methylmalonyl-CoA, is converted into succinylCoA by methylmalonyl-CoA mutase, an important step in the extraction of energy from proteins and fats. When there is a vitamin B12 deficiency, methylmalonyl-CoA is not converted by the enzyme and accumulates. Upon release of methylmalonyl-CoA in the plasma, coenzyme A is released and MMA levels rise. As a consequence, the vitamin B12 supply to the tissues is reflected by the level of MMA in plasma, showing an inverse correlation. c Springer International Publishing Switzerland 2016 J.P. Carvalho et al. (Eds.): IPMU 2016, Part I, CCIS 610, pp. 462–471, 2016. DOI: 10.1007/978-3-319-40596-4 39
Fuzzy Modeling for Vitamin B12 Deficiency
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However, MMA plasma levels may also be increased due to renal failure as a result of impaired filtration and secretion [2,7]. Therefore, increased MMA levels in plasma are not specific to vitamin B12 deficiency. To determine if a vitamin B12 deficiency is present based on MMA plasma level measurements, it is preferred to include measurements assessing kidney function. It is known that there is an influence of kidney function on MMA plasma levels but to the authors’ best knowledge the extend of this influence is unknown. In this paper we estimate the influence of the kidney function on MMA plasma levels using data analysis techniqu
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