Vitamin B-12, folate, iron, and vitamin A concentrations in rural Indian children are associated with continued breastfeeding, complementary diet, and maternal nutrition

Abstract

Background: Determinants of vitamin B-12, folate, iron, and vitamin A concentrations in young children in rural south Asia are poorly understood. These micronutrients are crucial for the production of hemoglobin and have other important physiologic functions. Objective: We sought to develop explanatory models for concentrations of vitamin B-12, folate, ferritin, and retinol binding protein (RBP) in children aged between 1 and 2 y in rural Karnataka, India. Design: We performed a cross-sectional study in 12-23-mo-old toddlers who lived in 2 rural districts of Karnataka, India. For each child, data concerning dietary, food-security, and sociodemographic and maternal factors were obtained, and serum vitamin B-12, folate, ferritin, and RBP were measured. Multiple regression and structural equation modeling were applied to determine associations with micronutrient concentrations. Results: Of 396 sampled children, 254 children (65.6%) had at least one micronutrient deficiency. With the use of multiple regression, continued breastfeeding was independently associated with the concentration of each micronutrient [(log) vitamin B-12: standardized coefficient of 20.30 (P , 0.001); folate: standardized coefficient of +0.20 (P , 0.001); (log) ferritin: standardized coefficient of 20.18 (P = 0.004); (log) RBP: standardized coefficient of20.21 (P , 0.001)]. Children who continued to breastfeed received less nutrition from complementary foods and belonged to poorer families with higher food insecurity. A structural equation model for children's vitamin B-12 concentrations was developed that highlighted the interrelation between wealth, continued breastfeeding, complementary diet, and vitamin B-12 concentrations in children.

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

“…Estimated dietary B 12 correlated with plasma B 12 concentration in Guatemalan schoolchildren (43) . B 12 intake from complementary foods was recently identified as an important determinant of plasma B 12 concentrations in toddlers in rural India, as well as in Guatemala (13,22) .…”

“…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.…”

“…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) .…”

“…There is also evidence of low B 12 status being related to increased cognitive decline in elderly people in the USA (20) . Several studies in low-and middle-income countries have identified significant correlations between dietary intakes of B 12 or consumption frequency of B 12 -rich foods and plasma B 12 in early childhood (13,(21)(22)(23)(24)(25)(26) . The association between diet and plasma B 12 concentration among older children remains under-studied.…”

Child factors associated with complementary feeding practices in Uganda

“…foods from animal sources such as eggs. 14,15 The age of the child is an important consideration in assessing the adequacy of complementary feeding practices. [16][17][18] Eruption of teeth influences when to introduce complementary feeding, but the process typically leads to a loss of appetite which affects food intake.…”