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Infant vitamin B12 status and its predictors - cross-sectional baseline results from an ongoing randomized controlled
Sol Maja G Bjørkevoll1, Maria O'Keeffe1, Carolien Konijnenberg2
1Department of Pediatric and Adolescent Medicine, Innlandet Hospital Trust, Lillehammer, Norway; Department of Global Public Health and Primary Care, Centre for International Health, University of Bergen, Bergen, Norway.
Insights
Many Norwegian infants show biochemical signs of low vitamin B12 status, particularly those who are breastfed. Further research is needed to understand the clinical significance of these findings in early infancy.
Area of Science:
- Pediatric Nutrition
- Biochemistry
- Public Health
Background:
- Vitamin B12 is essential for infant development.
- Assessing vitamin B12 status in infants is critical for early intervention.
- Biomarker cut-offs for vitamin B12 status are often based on adult data.
Purpose of the Study:
- To evaluate vitamin B12 status in Norwegian infants aged 6-15 weeks.
- To utilize multiple biomarkers and cut-off approaches for a comprehensive assessment.
- To identify predictors of vitamin B12 status in this infant population.
Main Methods:
- Recruited 644 infants (aged 6-15 weeks) and their mothers in Norway.
- Analyzed plasma cobalamin, methylmalonic acid (MMA), and total homocysteine (tHcy) concentrations.
- Calculated a combined indicator (cB12) and applied various cut-off methods to define vitamin B12 status.
Main Results:
- A significant proportion of infants exhibited biochemical indicators of low vitamin B12 status.
- Exclusively and partially breastfed infants showed lower vitamin B12 status compared to non-breastfed infants.
- Specific biomarker concentrations indicated potential deficiencies, with varying percentages across different cut-offs.
Conclusions:
- Many Norwegian infants present with biochemical signs suggestive of low vitamin B12 status.
- Breastfeeding status is associated with lower vitamin B12 biomarker levels.
- The clinical implications of these findings require further investigation in early infancy.
Background:
Vitamin B12 is a crucial micronutrient for infant growth and development.
Objective:
The objective of this study was to describe vitamin B12 status in Norwegian infants aged 6-15 wk using multiple biomarkers and cut-off approaches, and to identify its predictors.
Methods:
From November 2021 through August 2024, infants aged 6-15 wk and their mothers were recruited from public health clinics in Innlandet County, Norway, as part of an ongoing randomized controlled trial. Plasma cobalamin and methylmalonic acid (MMA) concentrations were analyzed among all infants in the cohort (n = 644), and total homocysteine (tHcy) concentrations were analyzed in a subgroup (n = 358). The combined indicator for vitamin B12 status (cB12) was calculated by Fedosov's equation. Low status was defined using multiple cut-off approaches. Potential predictors of infant vitamin B12 status were evaluated using regression models.
Results:
Mean (standard deviation [SD]) infant age was 9.1 (1.8) wk. The median (interquartile range) concentrations were: cobalamin 242 (192, 322) pmol/L, tHcy 7.4 (6.2, 9.4) μmol/L, and MMA 0.34 (0.21, 0.77) μmol/L. The mean (SD) cB12 was -0.5 (0.7). Eight percent had cobalamin <148 pmol/L, and 40% <221 pmol/L. Sixty-seven percent had tHcy >6.5 μmol/L, 19% >10 μmol/L, and 4% >13 μmol/L. Sixty-four percent had MMA>0.26 μmol/L. Exclusively breastfed infants had 40% lower cobalamin and 30% higher tHcy compared with nonbreastfed infants. Partially breastfed infants had 21% lower cobalamin and 12% higher tHcy compared with nonbreastfed infants.
Conclusion:
A substantial proportion of Norwegian infants have biochemical signs of low vitamin B12 status, given that the cut-offs were established in adults. Lower status was observed in partially and exclusively breastfed infants, compared with nonbreastfed infants. However, it is unclear whether these biomarker patterns have clinical significance. Further research is needed to determine consequences of low vitamin B12 biomarker concentrations in early infancy. This trial was registered as NCT05005897.
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