Which of the following is the most common cause of megaloblastic anemia in India?

Question

Accepted Answer

A. Dietary vitamin B12 deficiency in vegetarians. ## Epidemiology of Megaloblastic Anemia in India

**Key Point:** In India, **dietary vitamin B12 deficiency in vegetarians** is the most common cause of megaloblastic anemia, whereas in Western countries, pernicious anemia (autoimmune) is more prevalent.

### Geographic and Dietary Variation

| Cause | India | Western Countries |
|-------|-------|-------------------|
| **Dietary B12 deficiency** | Most common | Uncommon |
| **Pernicious anemia** | Uncommon | Most common |
| **Folate deficiency** | Common (second most) | Less common |
| **Malabsorption** | Moderate | Common |

**High-Yield:** India has a large vegetarian population, and B12 is found exclusively in animal products (meat, fish, eggs, dairy). Strict vegetarians and vegans are at high risk of dietary B12 deficiency.

### Why Pernicious Anemia Is Less Common in India

- Pernicious anemia is an autoimmune condition (antibodies against intrinsic factor or gastric parietal cells)
- More prevalent in Northern European populations and those of European descent
- Relatively rare in Indian and Asian populations
- Requires specific genetic and immunologic predisposition

**Clinical Pearl:** Always ask about dietary habits in an Indian patient with megaloblastic anemia. A vegetarian or vegan diet is a major risk factor for B12 deficiency.

### Folate Deficiency in India

- Second most common cause of megaloblastic anemia in India
- Causes: poor dietary intake, malabsorption (celiac disease, tropical sprue), increased demand (pregnancy, hemolysis)
- Tropical sprue (endemic in parts of India) is an important cause of folate malabsorption

Answer

B. Methotrexate therapy

Answer

C. Pernicious anemia due to intrinsic factor deficiency

Answer

D. Folate deficiency due to malabsorption

Which of the following is the most common cause of megaloblastic anemia in India?

Explanation

Epidemiology of Megaloblastic Anemia in India

Geographic and Dietary Variation

Why Pernicious Anemia Is Less Common in India

Folate Deficiency in India

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Cause	India	Western Countries
Dietary B12 deficiency	Most common	Uncommon
Pernicious anemia	Uncommon	Most common
Folate deficiency	Common (second most)	Less common
Malabsorption	Moderate	Common