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Folate, but not vitamin B-12 status, predicts respiratory morbidity in north Indian children^1,2,3,4,5

¹ From the Centre for International Health (TAS, NB, and HS) and the Section for Pharmacology, Institute of Medicine (PMU and JS), University of Bergen, Bergen, Norway; the All India Institute of Medical Sciences, New Delhi, India (ST and MKB); the Society for Applied Studies, Kolkata, India (ST and NB); the Institute of Basic Medical Sciences, Department of Nutrition, University of Oslo, Oslo, Norway (HR); the Oxford Centre for Gene Function, Department of Physiology, Anatomy & Genetics, Oxford University, Oxford, United Kingdom (HR); the Norwegian Institute of Public Health, Oslo, Norway (HKG); the World Health Organization, Geneva, Switzerland (RB); the Department of Medical Biosciences, Clinical Chemistry, University of Umeå, Umeå, Sweden (JS); and the Department of Biotechnology, New Delhi, India (MKB)

Background:Vitamin deficiencies are often part of malnutrition, which predisposes to acute lower respiratory tract infections.

Objective:The objective was to measure the association between cobalamin and folate status and subsequent respiratory morbidity.

Design:A prospective cohort study was conducted in 2482 children aged 6–30 mo nested in a zinc supplementation trial. We measured plasma concentrations of folate, cobalamin, methylmalonic acid, and total homocysteine (tHcy) and followed the children for 4 mo.

Results:We observed 1176 episodes of acute lower respiratory tract infections. Children with folate concentrations in the lowest quartile (interquartile range: 6.4–20.0 nmol/L) had a 44% higher incidence [adjusted incidence rate ratio (IRR): 1.44; 95% CI: 1.23, 1.70] of acute lower respiratory tract infections than did children in the other 3 quartiles. For tHcy, the IRR was 1.24 (1.07, 1.40) in a comparison of those in the highest quartile with those in the other quartiles. Breastfeeding was associated with high folate concentrations and protection against subsequent respiratory tract infections. This protection was significantly and substantially reduced after adjustment for plasma folate concentrations at baseline. Compared with the children in the other 3 quartiles, the IRR for being in the lowest quartile of cobalamin was 1.13 (0.76, 1.03) and for being in the highest quartile of methylmalonic acid was 1.12 (0.96, 1.31).

Conclusions:Poor folate status appears to be an independent risk factor for lower respiratory tract infections in young children. This study also suggests that the protective effect of breastfeeding is partly mediated by folate provided through breast milk.

Key Words: Children • pneumonia • folate • cobalamin • homocysteine • methylmalonic acid • malnutrition • cohort study • India

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				G. Hay, C. Johnston, A. Whitelaw, K. Trygg, and H. Refsum Folate and cobalamin status in relation to breastfeeding and weaning in healthy infants Am. J. Clinical Nutrition, July 1, 2008; 88(1): 105 - 114. [Abstract] [Full Text] [PDF]