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Prevalence and Predictors of Vitamin B12 Deficiency in Children with Severe Acute Malnutrition, and its Association
Aliya Atiq1, Dheeraj Shah2,3, Shikha Sharma4
1Department of Pediatrics, University College of Medical Sciences (University of Delhi) & Associated Guru Teg Bahadur Hospital, Dilshad Garden, New Delhi, 110095, India.
Insights
Vitamin B12 deficiency is common in children with severe acute malnutrition (SAM). This deficiency is linked to developmental delays in motor, cognitive, and language skills.
Area of Science:
- Nutritional Science
- Pediatric Health
- Developmental Pediatrics
Background:
- Severe acute malnutrition (SAM) affects millions of children globally.
- Vitamin B12 deficiency is a critical concern in pediatric populations, impacting overall health and development.
- Understanding the prevalence and consequences of vitamin B12 deficiency in SAM is crucial for effective intervention.
Purpose of the Study:
- To determine the prevalence of vitamin B12 deficiency in children diagnosed with SAM.
- To identify clinical predictors associated with vitamin B12 deficiency in this vulnerable group.
- To investigate the association between vitamin B12 deficiency and developmental outcomes in children with SAM.
Main Methods:
- A cross-sectional study involving 100 children aged 1 to 59 months diagnosed with SAM.
- Serum vitamin B12, folate, and ferritin levels were measured using chemiluminescence immunoassay.
- Serum homocysteine levels were assessed via enzymatic cycling, and developmental assessment was performed using the Denver Development Screening Tool (DDST-II).
Main Results:
- 45% of children with SAM exhibited vitamin B12 deficiency (<203 pg/mL).
- Hyperhomocysteinemia was observed in 39% of participants, with 69% of those having concurrent low vitamin B12 levels.
- Vitamin B12 deficiency was significantly associated with severe anemia and hypoproteinemia, and strongly correlated with delays in gross motor, fine motor, and adaptive-cognitive development.
Conclusions:
- A high prevalence of vitamin B12 deficiency exists in children with SAM.
- Vitamin B12 deficiency is significantly associated with developmental delays across multiple domains in children with SAM.
- Early detection and management of vitamin B12 deficiency are essential for improving developmental outcomes in children with severe acute malnutrition.
Objectives:
To determine the proportion of children with severe acute malnutrition (SAM) having vitamin B12 deficiency, its clinical predictors, and its association with development.
Methods:
In this cross-sectional study, 100 children between 1 mo to 59 mo [mean (SD) age 17 (12.75) mo; 55 males], with diagnosis of SAM as per WHO criteria, were included. Serum vitamin B12, serum folate, and serum ferritin levels were measured by chemiluminescence immunometric assay method, while serum Homocysteine (Hcy) level was measured by enzymatic cycling method. Development assessment was done by Denver Development Screening Tool (DDST-II).
Results:
The mean (SD) serum vitamin B12 (cobalamin) levels were 296.52 (246.95) pg/mL; 45% children were vitamin B12 deficient (<203 pg/mL). Hyperhomocysteinemia (>14 µmol/L) was present in 39 (39%), and among these 69% (27/39) children had concomitant low serum vitamin B12 levels. Severe anemia and hypoproteinemia were significantly and independently associated with vitamin B12 deficiency [aOR (95% CI) 3.22 (1.13, 10) and 10 (1.66, 58.82), respectively]. Out of 45 children who were vitamin B12 deficient, 93%, 87%, 62% and 80% had gross motor, fine-motor, language and adaptive-cognitive delay, respectively. Vitamin B12 level was significantly associated (P <0.001) with developmental delay.
Conclusions:
There is a high prevalence of vitamin B12 deficiency in children with SAM, which is also associated with development delay across all domains (except language) in these children.
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