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Multiple micronutrient supplementation improves vitamin B₁₂ and folate concentrations of HIV infected children in
Grace Ndeezi1, James K Tumwine, Christopher M Ndugwa
1Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. gracendeezi@yahoo.com
Insights
Nearly one-third of Ugandan children with HIV had low vitamin B12 and folate levels. Multiple micronutrient supplementation significantly improved these vitamin levels compared to standard care.
Area of Science:
- Pediatric Nutrition
- Infectious Diseases
- Micronutrient Research
Background:
- Vitamin B12 and folate status in African HIV-infected children is underreported.
- This study assesses vitamin B12 and folate levels in Ugandan children aged 1-5 years with HIV.
- The impact of multiple micronutrient supplementation on these vitamin levels is investigated.
Purpose of the Study:
- To determine the prevalence of vitamin B12 and folate deficiency in Ugandan children with HIV.
- To evaluate the efficacy of multiple micronutrient supplementation (MMS) in improving vitamin B12 and folate status.
- To compare the effects of MMS with a standard multivitamin (MV) supplement.
Main Methods:
- A total of 214 HIV-infected children (aged 1-5 years) were assessed for serum vitamin B12 and folate pre- and post-supplementation.
- Children were randomized to receive either a 14-multiple micronutrient supplement (MMS) or a standard 6-multivitamin (MV) supplement.
- Vitamin levels were measured using electrochemiluminescence immunoassay and competitive protein-binding assay; low levels were defined as <221 pmol/L for B12 and <13.4 nmol/L for folate.
Main Results:
- Prevalence of low vitamin B12 was 28% (60/214) and low folate was 29% (62/214).
- The MMS group showed significant increases in median vitamin B12 (285.5 to 401.5 pmol/L) and folate (17.3 to 27.7 nmol/L) (p < 0.001).
- The MV group showed no significant changes in vitamin B12 or folate concentrations from baseline.
Conclusions:
- A substantial proportion of HIV-infected Ugandan children exhibit deficiencies in vitamin B12 and folate.
- Multiple micronutrient supplementation is effective in enhancing vitamin B12 and folate status in this population.
- MMS demonstrates superior efficacy over standard multivitamins for improving these key nutrient levels in HIV-infected children.
Background:
The effect of multiple micronutrient supplementation on vitamin B₁₂ and folate has hither to not been reported in African HIV infected children. This paper describes vitamin B₁₂ and folate status of Ugandan HIV infected children aged 1-5 years and reports the effect of multiple micronutrient supplementation on serum vitamin B12 and folate concentrations.
Methods:
Of 847 children who participated in a multiple micronutrient supplementation trial, 214 were assessed for vitamin B₁₂ and folate concentrations pre and post supplementation. One hundred and four children were randomised to two times the recommended dietary allowance (RDA) of a 14 multiple micronutrient supplement (MMS) and 114 to a 'standard of care' supplement of 6 multivitamins (MV). Serum vitamin B12 was measured by an electrochemiluminescence immunoassay and folate by a competitive protein-binding assay using Modular E (Roche) automatic analyzer. Vitamin B₁₂ concentrations were considered low if less than 221 picomoles per litre (pmol/L) and folate if < 13.4 nanomoles per litre (nmol/L). The Wilcoxon Signed Ranks test was used to measure the difference between pre and post supplementation concentrations.
Results:
Vitamin B₁₂ was low in 60/214 (28%) and folate in 62/214 (29.0%) children. In the MMS group, the median concentration (IQR) of vitamin B₁₂ at 6 months was 401.5 (264.3 - 518.8) pmol/L compared to the baseline of 285.5 (216.5 - 371.8) pmol/L, p < 0.001. The median (IQR) folate concentrations increased from 17.3 (13.5-26.6) nmol/L to 27.7 (21.1-33.4) nmol/L, p < 0.001. In the 'standard of care' MV supplemented group, the median concentration (IQR) of vitamin B₁₂ at 6 months was 288.5 (198.8-391.0) pmol/L compared to the baseline of 280.0 (211.5-386.3) pmol/L while the median (IQR) folate concentrations at 6 months were 16.5 (11.7-22.1) nmol/L compared to 15.7 (11.9-22.1) nmol/L at baseline. There was a significant difference in the MMS group in both vitamin B₁₂ and folate concentrations but no difference in the MV group.
Conclusions:
Almost a third of the HIV infected Ugandan children aged 1-5 years had low serum concentrations of vitamin B₁₂ and folate. Multiple micronutrient supplementation compared to the 'standard of care' supplement of 6 multivitamins improved the vitamin B12 and folate status of HIV infected children in Uganda.
Trial Registration:
http://ClinicalTrials.govNCT00122941).
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