Cobalamin and folate status in infants and young children in a low-to-middle income community in India

Taneja, Sunita; Bhandari, Nita; Strand, Tor A.; Sommerfelt, Halvor; Refsum, Helga; Ueland, Per Magne; Schneede, Jörn; Bahl, Rajiv; Bhan, Maharaj Kishan

doi:10.1093/ajcn/86.5.1302

Cited by 109 publications

(99 citation statements)

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“…Vitamin B-12 status is the most important predictor for plasma tHcy in this population. 3 We found a substantial and significant reduction in tHcy concentration after folic acid or vitamin B-12 supplementation. The excellent compliance was reflected in a threefold increase in plasma folate concentrations.…”

Section: Figurementioning

confidence: 55%

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Vitamin B-12, Folic Acid, and Growth in 6- to 30-Month-Old Children: A Randomized Controlled Trial

et al. 2015

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BACKGROUND: Folate and vitamin B-12 are important for growth. Many children in low-and middle-income countries have inadequate intakes of these nutrients. METHODS:We undertook a randomized, placebo controlled double-blind trial in 1000 North Indian children, 6 to 35 months of age, providing twice the recommended daily allowance of folic acid and/or vitamin B-12, or placebo, daily for 6 months. By using a factorial design, we allocated children in a 1:1:1:1 ratio in blocks of 16. We measured the effect of giving vitamin B-12, folic acid, or the combination of both on linear and ponderal growth. We also identified predictors for growth in multiple linear regression models and effect modifiers for the effect of folic acid or vitamin B-12 supplementation on growth. RESULTS:The overall effect of either of the vitamins was significant only for weight; children who received vitamin B-12 increased their mean weight-for-age z scores by 0.07 (95% confidence interval: 0.01 to 0.13). Weight-for-age z scores and height-for-age z scores increased significantly after vitamin B-12 supplementation in wasted, underweight, and stunted children. These subgrouping variables significantly modified the effect of vitamin B-12 on growth. Vitamin B-12 status at baseline predicted linear and ponderal growth in children not receiving vitamin B-12 supplements but not in those who did (P-interaction , .001). CONCLUSIONS:We provide evidence that poor vitamin B-12 status contributes to poor growth. We recommend studies with larger doses and longer follow-up to confirm our findings. WHAT'S KNOWN ON THIS SUBJECT:Micronutrient deficiencies, including deficiencies of vitamin B-12 and folate, are common worldwide and may be a contributing factor to the estimated 165 million stunted children. WHAT THIS STUDY ADDS:Routine supplementation of vitamin B-12 improved linear and ponderal growth in subgroups of young Indian children. We provide evidence that vitamin B-12 deficiency is a contributor to poor growth in low-and middle-income countries.

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Section: Figurementioning

confidence: 55%

“…[1][2][3] The main source of vitamin B-12 is animal-derived foods, which are expensive and for cultural and religious reasons often not eaten at all. 1 In addition to breast milk, the best sources of folates are dark-green vegetables and legumes.…”

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Vitamin B-12, Folic Acid, and Growth in 6- to 30-Month-Old Children: A Randomized Controlled Trial

et al. 2015

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“…This dietary regimen at least partly explains the magnitude of vit B12 deficiency (49%), and the lower incidence of folic acid deficiency (11%) in this population. More or less the same scenario is observed in different regions and populations in India (Refsum et al, 2001;Yajnik et al, 2006;Taneja et al, 2007;Kumar et al, 2009a, b). It is important to note that even Western and South-East Asian populations do not show such high incidence of vitamin B12 deficiency as seen in Indian populations (Gamble et al, 2005;McLean et al, 2008;Elmadfa and Singer, 2009;Thuesen et al, 2010;Waskiewicz et al, 2010).…”

Section: Hcy-modulation and Micronutrientsmentioning

confidence: 57%

Association of MTHFR and RFC1 gene polymorphism with hyperhomocysteinemia and its modulation by vitamin B12 and folic acid in an Indian population

Sukla

Raman

2011

Eur J Clin Nutr

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Background/Objectives: Unlike most Western populations, MTHFR 677T is a rare allele and a risk factor for a variety of disorders in India. What kind of nutritional (environmental) and/or genetic factors could contribute to the genetic risk is not known. To assess the incidence of hyperhomocysteinemia and its correlation with the polymorphism in homocysteine (Hcy)-pathway genes and associated cofactors in the native populations of eastern India. Subjects/Methods: Healthy population from four eastern states of India. Genotyping of SNPs, HPLC and chemiluminescencebased assay for homocysteine, vitamin B12 and folic acid.Results: Approximately 30% of the population has hyperhomocysteinemia (415 mmol/lit; hypHcy) with varying frequencies in the four states from where samples were collected (n ¼ 1426). Polymorphisms of MTR and CBS do not affect hypHcy. 677T and 1298C alleles of MTHFR and G80 RFC-1 show association with hypHcy. In contrast, RFC-1 80AA is protective even in presence of 677T MTHFR. Addition of each mutant allele has an additive effect on Hcy level. Vitamin B12 (cofactor in methionine synthesis) clearly modulates the genotypic effect on Hcy level. Although frequency of individuals with low folic acid is B11, 49% of the population is vitamin B12 deficient (o220 pg/lit) and has a significant negative correlation with Hcy. Individuals with optimum vitamin B12 and folic acid generally have low Hcy, even in risk genotypes. Conclusions: One of the plausible reasons for susceptibility of individuals with MTHFR C677T in the studied population to various disorders is the high frequency of hyperhomocysteinemia and vitamin B12 deficiency in the 'healthy population'. Apparently, supplementation of vitamin B 12 to this health-impoverished community may help lessen the risk of several multifactorial disorders.

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“…There are currently no standard criteria for defining B 12 deficiency in children, but 2·5 % were deficient according to the adult definition and a further 14 % had 'marginal' status. Given that rates of deficiency in India have been measured at 1-44 %, the prevalence in our cohort could be considered low (10)(11)(12)(13)(14) . However the 150 pmol/l cut-off was derived for adults and may not be a valid measure of deficiency for children.…”

Section: Summary Of Main Findingsmentioning

confidence: 99%

“…There is no standard definition of deficiency among children and there is a paucity of data on B 12 status among Indian children. However, recent studies using adult cut-offs have reported that 2-44 % of infants and school-age children are deficient (10)(11)(12)(13)(14) . A study in Pune, India showed normal B 12 absorption in the majority (90 %) of individuals studied (15) .…”

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Contribution of food sources to the vitamin B₁₂ status of South Indian children from a birth cohort recruited in the city of Mysore

Christian

Krishnaveni

Kehoe

et al. 2014

Public Health Nutr.

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Objective: There is evidence that subclinical vitamin B 12 (B 12 ) deficiency is common in India. Vegetarianism is prevalent and therefore meat consumption is low. Our objective was to explore the contribution of B 12 -source foods and maternal B 12 status during pregnancy to plasma B 12 concentrations. Design: Maternal plasma B 12 concentrations were measured during pregnancy. Children's dietary intakes and plasma B 12 concentrations were measured at age 9·5 years; B 12 and total energy intakes were calculated using food composition databases. We used linear regression to examine associations between maternal B 12 status and children's intakes of B 12 and B 12 -source foods, and children's plasma B 12 concentrations. Setting: South Indian city of Mysore and surrounding rural areas. Subjects: Children from the Mysore Parthenon Birth Cohort (n 512, 47·1 % male). Results: Three per cent of children were B 12 deficient (<150 pmol/l). A further 14 % had 'marginal' B 12 concentrations (150-221 pmol/l). Children's total daily B 12 intake and consumption frequencies of meat and fish, and micronutrient-enriched beverages were positively associated with plasma B 12 concentrations (P = 0·006, P = 0·01 and P = 0·04, respectively, adjusted for socio-economic indicators and maternal B 12 status). Maternal pregnancy plasma B 12 was associated with children's plasma B 12 concentrations, independent of current B 12 intakes (P < 0·001). Milk and curd (yoghurt) intakes were unrelated to B 12 status. Conclusions: Meat and fish are important B 12 sources in this population. Micronutrient-enriched beverages appear to be important sources in our cohort, but their high sugar content necessitates care in their recommendation. Improving maternal B 12 status in pregnancy may improve Indian children's status. KeywordsIndia Vitamin B 12 Child Source Vitamin B 12 (B 12 ), or cobalamin, plays a key role in cellular metabolism and DNA synthesis (1) . It is produced in nature only by microbial synthesis and animal products are the principal dietary sources for man. Uncooked plant-based foods contaminated with B 12 -synthesising bacteria, and fermented foods, may also be important sources (2,3) . In India, vegetarian diets have been associated with an increased risk of B 12 deficiency and a high prevalence of B 12 deficiency has been attributed to low meat intakes for religious or economic reasons (2,4) . Prevalence rates of deficiency of 47-71 % have been reported among adults (4)(5)(6)(7)(8)(9) . There is no standard definition of deficiency among children and there is a paucity of data on B 12 status among Indian children. However, recent studies using adult cut-offs have reported that 2-44 % of infants and school-age children are deficient (10)(11)(12)(13)(14) . A study in Pune, India showed normal B 12 absorption in the majority (90 %) of individuals studied (15) . Severe B 12 deficiency, as seen in pernicious anaemia, is characterised by megaloblastic anaemia and/or neurological dysfunction. However, subclinical cobalamin defici...

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Cobalamin and folate status in infants and young children in a low-to-middle income community in India

Cited by 109 publications

References 44 publications

Vitamin B-12, Folic Acid, and Growth in 6- to 30-Month-Old Children: A Randomized Controlled Trial

Vitamin B-12, Folic Acid, and Growth in 6- to 30-Month-Old Children: A Randomized Controlled Trial

Association of MTHFR and RFC1 gene polymorphism with hyperhomocysteinemia and its modulation by vitamin B12 and folic acid in an Indian population

Contribution of food sources to the vitamin B₁₂ status of South Indian children from a birth cohort recruited in the city of Mysore

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Cobalamin and folate status in infants and young children in a low-to-middle income community in India

Cited by 109 publications

References 44 publications

Vitamin B-12, Folic Acid, and Growth in 6- to 30-Month-Old Children: A Randomized Controlled Trial

Vitamin B-12, Folic Acid, and Growth in 6- to 30-Month-Old Children: A Randomized Controlled Trial

Association of MTHFR and RFC1 gene polymorphism with hyperhomocysteinemia and its modulation by vitamin B12 and folic acid in an Indian population

Contribution of food sources to the vitamin B12 status of South Indian children from a birth cohort recruited in the city of Mysore

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Contribution of food sources to the vitamin B₁₂ status of South Indian children from a birth cohort recruited in the city of Mysore