American Journal of Clinical Nutrition, Vol 26, 595-599, Copyright © 1973 by The American Society for Clinical Nutrition, Inc.

Vitamin B₁₂ absorption in protein—calorie malnourished children and during recovery: influence of protein depletion and of diarrhea

¹ From the Biomedical Division, Institute of Nutrition of Central America and Panama (INCAP), Guatemala, C. A.

The absorption of ⁵⁷Co-vitamin B₁₂ was studied by means of the Schilling test in 25 severely protein—calorie malnourished children upon admission to the hospital. In 10 of these, the effect of simultaneous intrinsic factor was evaluated, and absorption studies were repeated after 12 days of therapeutic diet. Ten fully recovered children served as controls.

Results indicate that in severe PCM, vitamin B₁₂ absorption is low and does not improve with intrinsic factor administration (the mean ± sd urinary excretion of ⁵⁷Co-B₁₂ as percent of dose without intrinsic factor was 12.3 ± 9.5; with intrinsic factor, it was 8.4 ± 7.3). During early recovery, the percent urinary excretion of ⁵⁷Co rose to 17.0 ± 10.1. These tests were done with the administration of intrinsic factor. The values obtained in fully recovered children were 31.4 ± 9.7; these are similar to those obtained in children with pernicious anemia to whom intrinsic factor is given.

In severely malnourished children and during their early recovery, diarrhea produces a marked drop in vitamin B₁₂ absorption, but children without diarrhea in the same clinical stages will absorb subnormal amounts of vitamin B₁₂. Vitamin B₁₂ absorption correlates with the creatinine height index (r = 0.493), suggesting that the degree of protein depletion influences vitamin B₁₂ absorption. These results are discussed in the light of the possible role the terminal ileum might have in the altered bile salt metabolism described in PCM children and in the presence of diarrhea.