High Prevalence of Vitamin B12 Deficiency and No Folate Deficiency in Young Children in Nepal

Abstract

Many children in low- and middle-income countries may have inadequate intake of vitamin B12 and folate; data confirming these inadequacies are limited. We used biochemical, demographic, behavioral and anthropometric data to describe the folate and vitamin B12 concentrations among six- to 23-month-old Nepalese children. Vitamin B12 (serum B12 < 150 pmol/L) and folate deficiencies (red blood cell (RBC) folate < 226.5 nmol/L) were assessed. We used logistic regression to identify predictors of vitamin B12 deficiency. The vitamin B12 geometric mean was 186 pmol/L; 30.2% of children were deficient. The mean RBC folate concentration was 13,612 nmol/L; there was no deficiency. Factors associated with vitamin B12 deficiency included: (a) age six to 11 months (adjusted odds ratio (aOR) 1.51; 95% confidence interval (CI): 1.18, 1.92) or 12–17 months (aOR 1.38; 95% CI: 1.10, 1.72) compared to 18–23 months; (b) being stunted (aOR 1.24; 95% CI: 1.03, 1.50) compared to not being stunted; (c) and not eating animal-source foods (aOR 1.85; 95% CI: 1.42, 2.41) compared to eating animal-source foods the previous day. There was a high prevalence of vitamin B12 deficiency, but no folate deficiency. Improving early feeding practices, including the consumption of rich sources of vitamin B12, such as animal-source foods and fortified foods, may help decrease deficiency.

Cobalamin and Folate Status among Breastfed Infants in Bhaktapur, Nepal

“…Our findings of excellent folate status in this population may partly be explained by high iron/folic acid intake by mothers during pregnancy, breastfeeding and the availability of folate in vegetarian foods given to infants [ 30 , 47 ]. Similar findings of high folate status but low cobalamin were found in a recent study from Nepal among 6–23 months old children from Kapilvastu and Achham districts [ 31 ], and in our previous studies from the same community among children [ 8 , 47 ] and mothers [ 7 ]. In these studies, folate deficiency was also uncommon, but cobalamin deficiency based on low plasma cobalamin ranged from 17–41%.…”

“…Data on cobalamin and folate status covering a panel of biomarkers particularly from healthy infants from this age group are rare. Available published data are based on limited markers in children with a wide age range (6–23 months) [ 31 ] or from clinical populations [ 8 , 59 ]. Furthermore, we also collected detailed information on antenatal micronutrient supplementation, which may influence cobalamin and folate status of the offspring [ 60 ].…”

“…However, data on status of micronutrients including cobalamin and folate from breastfed infants from Nepal are still lacking. Because of rapid growth and development, infants are particularly vulnerable to micronutrient deficiencies [ 6 , 31 ]. A focus on maximizing nutrition during the second half of infancy is crucial as most of the growth faltering starts during this period [ 32 , 33 ], which may also have long-term and intergenerational consequences [ 34 , 35 ].…”

Vitamin B12 Serum Levels of Six to Nine-monthold Infants According to Feeding Practices

“…Vitamin B12 deficiency is a health worry generally encountered in developing countries (5). Vitamin B12 is critical for development during the fetal, neonatal, and infancy periods.…”

“…Vitamin B12 fortified foods and supplements, in addition to animalderived foods, can be consumed in cases of deficiency (2). Vitamin B12 inadequacy is prevalent in those on strict vegetarian or vegan regimes as well as in individuals who live in developing countries (3)(4)(5)(6).…”