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Cobalamin and folate status in infants and young children in a low-to-middle income community in India^1,2,3

¹ From the Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India (ST, NB, RB, and MKB); the Center for International Health, University of Bergen, Bergen, Norway (TAS and HS); 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 Section for Pharmacology, Institute of Medicine, University of Bergen, Bergen, Norway (PMU); the Department of Clinical Chemistry, University of Umea, Umea, Sweden (JS); the Department of Biotechnology, New Delhi, India (MKB); and the Society for Applied Studies, New Delhi, India (ST and NB)

Background: Population-based data on the prevalence of cobalamin and folate deficiency in India are lacking.

Objective: The objective was to measure the prevalence of cobalamin and folate deficiency among children aged 6–30 mo residing in a low-to-middle income community in North India.

Design: Children aged 6–30 mo (n = 2482) were identified through a community survey in a low-to-middle socioeconomic area in New Delhi, India. Non-fasting venous blood samples were collected before enrollment in another trial.

Results: The median (interquartile range; IQR) cobalamin concentration in 6–11-mo-old children was substantially lower in breastfed (183; 120–263 pmol/L) than in nonbreastfed (334; 235–463 pmol/L) children. Cobalamin concentrations decreased progressively with increasing age in the nonbreastfed children. Median (IQR) plasma folate concentrations in the 6–11-mo-old group were higher in breastfed (20.3; 11.7–34.4 nmol/L) than in nonbreastfed (5.3; 3.4–7.7 nmol/L) children (P < 0.001). Folate concentrations decreased with increasing age in the breastfed children. In the nonbreastfed children, folate concentrations increased with increasing age. Low concentrations of plasma cobalamin (<150 pmol/L) were detected in 36% of breastfed and 9% of nonbreastfed children (P < 0.001). The proportions of children with plasma folate concentrations <5 nmol/L in these 2 subgroups were 6% and 33%, respectively (P < 0.001).

Conclusions: In north Indian preschool children, cobalamin and folate concentrations were commonly low and were associated with elevated total homocysteine and methylmalonic acid concentrations. Because low cobalamin and folate concentrations have functional consequences, population-based measures for improving cobalamin and folate concentrations need to be seriously considered.

Key Words: Cobalamin • folate • homocysteine • methylmalonic acid • children • India

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