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To investigate the association between plasma concentration of vitamin B 12 and B 12 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 B 12 intake, serum vitamin B 12 , and holotranscobalamin (holoTC) concentration. B 12 supplements had a significantly positive association with plasma B 12 among all subjects ( p trend &lt; 0.001), especially among vegans and lacto-ovo vegetarians ( p trend &lt; 0.001). Among non-users of B 12 supplements, B 12 intake from milk substitutes was significantly positively associated with holoTC ( p trend &lt; 0.004) and serum B12 ( p trend &lt; 0.030). In non-vegetarians, holoTC was significantly positively associated with B 12 intake from eggs, while serum B 12 was significantly positively associated with B 12 intake from milk in the upper tertile compared to the lower, and B 12 intake from meat in the middle compared to the lower tertile intake ( p &lt; 0.011). Supplements containing B 12 followed by B 12 intake from milk substitutes were significant contributors of plasma vitamin B 12 concentration.

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