Cobalamin and folate status in malnourished children

Abstract

Background: Vitamin B12 and folate are essential micronutrients which are critical especially during infancy and early childhood as these are periods of rapid growth, development, and increased demand. Malnutrition further increases the risk of these micronutrient deficiency due to poor socioeconomic status, inadequate intake and poor absorption. Aim of present work was to study the cobalamin and folate status in malnourished children.Methods: A hospital based observational study on 80 children suffering from severe acute malnutrition (SAM) aged 6-60 months. Detailed socio-economic, feeding and development history with complete anthropometric evaluation was done. Blood samples sent for measurement of plasma vitamin B12 and serum folate levels. Statistical analysis was done using SPSS version 20.0.Results: Mean age of SAM children was 17.25±12.60 months. 30 (37.5%) had vitamin B12 deficiency (vitamin B12 levels<100pg/ml) and 9 (11.25%) had borderline vitamin B12 levels (100-200pg/ml). Folate deficiency was found in only 7 (8.75%) children. Mean vitamin B12 and folate levels were found to be 353.65±330.76pg/ml, 11.18±4.17ng/ml respectively. Among vitamin B12 deficient children, majority (26, 86.66%) belong to lower socio-economic status, 17 (56.66%) were still predominantly on breast feeding and 11 (36.66%) had delayed introduction of complementary feeding. Among B12 deficient children 23 (76.66%) had delayed development (DQ <70). 100% of B12 deficient children were anemic with majority (21,70%) having severe anemia. 17 (56.66%) B12 deficient children also had associated thrombocytopenia (PC <1.5 lakh/cumm).Conclusions: There was a high prevalence of vitamin B12 deficiency among malnourished children. Folate deficiency was found only in few. Efforts should be directed to prevent its deficiency in pregnant and breastfeeding women and their infants with special attention on malnourished children.

Development delay in children with severe acute malnutrition and its association with Vitamin B12 deficiency

“…2 Lower prevalence in this study could be because the study group was not SAM. A study done by Goyal S et al (2017) in Udaipur in 80 SAM children showed vitamin B12 deficiency in 37.5 % and insufficiency in 11.25 % children with overall prevalence of low vitamin B12 levels of 48.75% similar to our study. 3 The mean vitamin B12 level in the above study was 353.65 ± 330.76 pg/ml which is much lower than that in our study.…”

“…which may further lead to deterioration of nutritional status of the children because of decreased food intake. [3][4][5] In first two years of life, brain growth and myelination is very rapid and Vitamin B12 deficiency results in restricted myelination, resulting in various neurological and intellectual problems in children including development delay.…”

Estimation of serum folate and vitamin B12 levels in children with severe acute malnutrition

“…Over the last few years, the number of cases of vitamin B12 deficiency are increasing as compared to folic acid deficiency. 13 In a study by Chhabra A et al, they concluded that nutritional megaloblastic anaemia occurs commonly in malnourished children; the commonest age is 3-18 months. 15 These children were exclusively breast fed by mothers who have had poor cobalamine levels and undernourished.…”

“…(Table 1and 2). 13 Folic acid deficiency is seen in 3(3.8%) children (Table 3). Mean Vitamin B12 and folate levels being 384.61 and 8.95 respectively.…”

“…1 The decreasing trend in Iron & Folate deficiency could be due implementation of the National Anaemia Control Programme where mother and children receive iron and folic acid tablets regularly. 13 There are limited studies on changing trend of Vitamin B12 deficiency in patients with SAM. This study has been undertaken to estimate the serum folate and vitamin B12 status in malnourished children.…”