Submitted to: Journal of Nutrition
Publication Type: Peer reviewed journal
Publication Acceptance Date: 2/15/2007
Publication Date: 4/24/2007
Citation: Jones, K.M., Ramirez-Zea, M., Zuleta, C., Allen, L.H. 2007. Prevalent vitamin B-12 deficiency in twelve-month-old Guatemalan infants is predicted by maternal B-12 deficiency and infant diet. Journal of Nutrition. 1307:1307-1313. Interpretive Summary: The quality of diets in low-income populations indeveloping countries is compromised by limited access to high-cost, nutrient-rich foods, especially animal source foods (ASF). Diets lacking ASF are associated with a higher prevalence of inadequate micronutrient intakes and deficiencies, including vitamin B-12, iron, zinc, and riboflavin. Vitamin B-12 (cobalamin) deficiency is a particular risk because this vitamin is found only in ASF, fortified foods, and supplements. A high prevalence of low plasma vitamin B-12 concentrations has been reported in both sexes and across age groups in low-income communities in Latin America, Southeast Asia, and Africa. In a review of 9 studies and surveys from Latin America, marginal or deficient plasma vitamin B-12 concentrations were detected in =40% of individuals across all age groups, and in Guatemala specifically, in at least on third of peri-urban infants, schoolers, and women. In Guatemalan schoolers, plasma vitamin B-12 concentration was associated with their estimated dietary intake of the vitamin, suggesting that low intake of ASF and/or vitamin B-12 fortified foods contributes to deficiency in this population.
Technical Abstract: Marginal (<148 pmol/L) or deficient (148-220 pmol/L) plasma vitamin B-12 concentrations were reported previously in approximately one third of low-income women and children studied in Guatemala. Since vitamin B-12 deficiency can adversely affect infant development and cognitive function, this study examined predictors of deficient plasma vitamin B-12 concentrations at age 12 mo. Analyses were performed on baseline data from a reandomized clinical trial in 304 Guatemalan infants, 80% of whom were partially breastfed, and their mothers. Exclusion criteria for infants included twins, severe stunting or moderate wasting, reported major health problems, severe developmental delay, hemoglobin (Hb) <95 g/L, maternal age <17y, and maternal pregnancy >3 mo. Data collected included socio-economic status, infant anthropometry, vitamin B-12 intake from complementary foods, and breastfeeding frequency reported by mothers. A complete blood count (CBC), and plasma vitamin B-12, folate, ferritin, and C-reactive protein (CRP) were measured. Deficient or marginal plasma vitamin B-12 concentrations were found in 49% of infants and 68% of mothers. Maternal vitamin B-12 intake average 3.1 ug/d, and infants consumed 2.2 ug/d from complementary foods. In linear regression analysis, infant plasma B-12 concentration was strongly and positively associated with maternal plasma vitamin B-12 and B-12 intake from complementary foods (predominantly powdered cow's milk), and inversely associated with frequency of breastfeeding and larger household size (p<0.0001). Vitamin B-12 supplementation of lactating women, food fortification, and education to improve infant's vitamin B-12 status are potential interventions to improve the vitamin B-12 status of mothers and infants in this population.