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Vitamin B12 deficiency in children from Northern India: Time to reconsider nutritional handicaps
Swati Umasanker1, Rahul Bhakat1, Sonalika Mehta1
1Department of Pediatrics, All India Institute of Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
Insights
Subclinical Vitamin B12 deficiency is prevalent in Indian children, affecting two-thirds of anemic cases. Early detection is crucial as deficiency presents with lethargy, weight loss, and neurological issues, especially in younger children.
Area of Science:
- Pediatric Nutrition
- Hematology
- Clinical Research
Background:
- Subclinical Vitamin B12 deficiency is a significant health concern in the Indian subcontinent.
- It has profound clinical and socio-economic implications.
Purpose of the Study:
- To determine the prevalence of Vitamin B12 deficiency in children.
- To characterize the clinical profile of deficient children.
Main Methods:
- Prospective analytical study in a tertiary care hospital in Northern India.
- Inclusion of children with clinical pallor.
- Recording of detailed history, anthropometric data, clinical features, complete blood counts, mean corpuscular volume, and Vitamin B12 levels.
Main Results:
- 64.8% of the 111 included children were Vitamin B12 deficient.
- Common symptoms included lethargy, weight loss, and knuckle pigmentation.
- Neurological manifestations were observed in one-fifth of the children, with associations to fragile hair and knuckle pigmentation.
Conclusions:
- Two-thirds of anemic children exhibited Vitamin B12 deficiency.
- Neurological manifestations were more common in younger children (<6 years), while hematological issues were more frequent in older children (≥6 years).
- Vitamin B12 level assessment is vital for anemic children, irrespective of dietary habits or normal Mean Corpuscular Volume (MCV).
Background And Aims:
Subclinical Vitamin B12 deficiency is a very common entity in the Indian subcontinent with devastating clinical and socio-economic consequences. The objective of this study was to estimate the proportion of vitamin B12 deficient children and to evaluate their clinical profile.
Setting And Design:
This prospective analytical study was conducted in a tertiary level care institute in Northern India.
Materials And Methods:
Children with clinical pallor, were included in this study. Detailed history, height, weight percentiles and characteristic features of vitamin B12 deficiency were recorded and complete blood counts, mean corpuscular volume and vitamin B12 levels were done.
Statistics:
For Qualitative data was analyzed using Pearson Chi square tests and quantitative data was analyzed using two sided independent samples t tests.
Results:
A total of 111 children were included. 64.8% (n = 72) had vitamin B12 deficiency. Lethargy (63.9%) and weight loss (62.1%), Knuckle pigmentation were common features. One-fourth of the children were on vegetarian diet. Neurological manifestations were significantly associated with fragile hair (p 0.056) and knuckle pigmentation (p 0.027). Younger children had more weight loss (p 0.001), knuckle pigmentation (p 0.019) and hypotonia (p 0.045). One fifth of children presented with neurological manifestations.
Conclusions:
Two-thirds of the anemic children had vitamin B12 deficiency. There was a bimodal age distribution with regard to B12 deficiency. Neurological manifestations were predominant in younger children [<6] and hematological abnormalities were more frequent in older children [≥6 years]. Estimation of vitamin B12 levels forms an essential component while evaluating children with anemia, despite mixed dietary habits and normal MCV.
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