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American Journal of Clinical Nutrition, Vol. 88, No. 1, 105-114, July 2008
© 2008 American Society for Nutrition

ORIGINAL RESEARCH COMMUNICATION

Folate and cobalamin status in relation to breastfeeding and weaning in healthy infants1,2,3

Gry Hay1, Carole Johnston1, Andrew Whitelaw1, Kerstin Trygg1 and Helga Refsum1

1 From the Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway (GH, KT, and HR); the Department of Physiology, Anatomy, and Genetics, University of Oxford, Oxford, United Kingdom (CJ); and the Department of Clinical Science, University of Bristol, Bristol, United Kingdom (AW)

Background: Folate and cobalamin status changes markedly during infancy.

Objective: We aimed to examine the influence of breastfeeding on folate and cobalamin status in healthy infants.

Design: In a longitudinal study, we measured serum folate, cobalamin, holotranscobalamin, holohaptocorrin, methylmalonic acid, and homocysteine at birth and at ages 6, 12, and 24 mo (n = 361, 262, 244, and 224, respectively). Breastfeeding status and nutrient intake were assessed by using questionnaires and 7-d weighed-food records (at 12 mo).

Results: All indexes changed significantly from birth to age 24 mo (P < 0.001). Folate was high until age 6 mo and then declined. At age 6 mo, folate was positively correlated with duration of exclusive breastfeeding ({rho} = 0.29; P < 0.001). Cobalamin status declined after birth in breastfed but increased in nonbreastfed infants. Thus, holotranscobalamin (pmol/L) was lower in breastfed than in nonbreastfed children at age 6 mo [geometric x: 37 (95% CI: 33, 40) and 74 (64, 86), respectively], at 12 mo [51 (46, 56) and 76 (70, 82), respectively], and at 24 mo [65 (50, 83) and 90 (85, 97), respectively; P < 0.05 for all]. Complementary feeding did not increase (6 mo) or modestly increased (12 mo) cobalamin status in breastfed children. At 12 mo, cobalamin intake (µg/d), excluding breast milk cobalamin, was lower in breastfed than in nonbreastfed infants [geometric x: 1.4 (1.3, 1.6) and 2.4 (2.1, 2.6), respectively; P < 0.001]. However, after adjustment for total cobalamin intake, cobalamin status (ie, holotranscobalamin) remained significantly lower in breastfed than in nonbreastfed infants [54 (49, 59) and 70 (64, 78), respectively; P < 0.001].

Conclusions: Low cobalamin status is a characteristic finding in breastfed children. Reference limits according to age and breastfeeding status should be considered in early childhood.






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