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Vitamin B12 and folic acid absorption and hematological status in children with postenteritis enteropathy
A Paerregaard1, K Hjelt, P A Krasilnikoff
1Department of Pediatrics, University of Copenhagen, Gentofte Hospital, Denmark.
Insights
Children with postenteritis enteropathy show impaired vitamin B12 absorption despite intact folic acid absorption. This malabsorption can lead to vitamin B12 depletion, especially with poor diet.
Area of Science:
- Pediatrics
- Gastroenterology
- Nutritional Science
Background:
- Postenteritis enteropathy involves persistent small-intestinal mucosal damage and failure-to-thrive after gastroenteritis.
- Nutrient absorption is crucial for recovery and growth in affected children.
Purpose of the Study:
- To investigate vitamin B12 and folic acid absorption capacities in children with postenteritis enteropathy.
- To compare absorption with hematological status during maximal growth retardation and recovery.
Main Methods:
- Utilized a double-isotope technique with a single-stool-sample test to determine fractional absorption of vitamin B12 (FAB12) and folic acid (FAFol).
- Examined nine children during maximal growth retardation and again during late recovery.
Main Results:
- Vitamin B12 absorption was markedly reduced (FAB12 below normal in 50% of children), while folic acid absorption remained largely intact.
- FAB12 was significantly lower during maximal growth retardation compared to the recovery period (p < 0.005).
- Moderate iron deficiency was noted in half the children; plasma vitamin B12 and folate levels were unaffected.
Conclusions:
- Postenteritis enteropathy significantly impairs vitamin B12 absorption, but not folic acid absorption.
- Reduced vitamin B12 absorption, coupled with low dietary intake, poses a risk for vitamin B12 depletion in vulnerable populations.
- Monitoring vitamin B12 status is critical in children with persistent gastrointestinal issues.
Abstract:
In a group of nine children with postenteritis enteropathy (i.e., persisting small-intestinal mucosal damage and failure-to-thrive after an acute episode of gastroenteritis), absorption capacities for vitamin B12 and folic acid were studied and compared with hematological status in peripheral blood. The fractional absorptions of vitamin B12 (FAB12) and folic acid (FAFol) were determined by means of a double-isotope technique employing a single-stool-sample test. The children were examined when growth retardation was maximal, and examinations were repeated during the late recovery period. In spite of considerable small-intestinal mucosal damage, only the absorption of vitamin B12 was markedly affected, while that of folic acid was almost intact. When growth retardation was maximal, FAB12 was below the normal age-correlated range in half of the children. FAB12 was also severely reduced in all longitudinally observed children when compared with the results obtained during the late recovery period (p less than 0.005). FAFol was below the normal range in one fourth of the children, but the reduction was modest and insignificant when compared with the results of repeated examinations during the late recovery period. A moderate iron deficiency was detected in half the children. High levels of plasma vitamin B12, folic acid, and erythrocyte folate were detected at both early and later examinations, indicating that these parameters were not affected by the reduced absorption capacities. However, if malabsorption and chronic diarrhea are combined with low dietary intake of vitamin B12, as is the case for many children in the Third World, depletion of vitamin B12 stores may result.