Vitamin B12 may improve growth in malnourished children

By C. Vidya Shankar MD

NEW YORK (Reuters Health) - Vitamin B12 supplements may significantly improve the weight and height of undernourished children, according to results of a new study from India.

"Vitamin B12 is a growth-limiting nutrient, and deficiency may contribute to the all-too high number of chronic malnourished children," lead author Dr. Tor Strand, from the Innlandet Hospital Trust, Lillehammer, Norway, told Reuters Health by email.

Foods rich in B12, including animal products, are either too costly or not consumed due to cultural reasons in many parts of the world, the researchers say.

Their trial enrolled 1000 children aged 6 and 35 months from Delhi, India. They aimed to study the benefits of vitamin B12 and folate supplements in reducing diarrhea and chest infections. They reported on the secondary objective of its effects on weight and height of young children in an article published online March 23 in the Pediatrics.

The researchers randomized the children in approximately equal numbers to receive: 1) placebo, 2) twice the recommended daily allowance (RDA) of B12, 3) twice the RDA of folic acid, or 4) a combination of B12 and folate. Children under a year old had spoonfuls (5 grams) of a paste and those older than a year received two spoonfuls daily, excluding Sundays and public holidays, for six months. The paste contained 150 micrograms of folic acid or 1.8 micrograms of B12 per 10 grams.

The researchers monitored all children during twice-weekly visits. They measured weight and height at baseline and end of follow-up. They took blood samples at baseline for all children and at 26 weeks for 16 randomly selected blocks to test for B12, folate, and plasma homocysteine prior to and after completion of the study. They then calculated weight for age (WAZ), height for age (HAZ), and weight for height Z scores.

Wasting, stunting, and underweight were defined less than -2 Z scores for weight for height, height for age, and weight for age. At baseline, approximately a third of the children were underweight, stunted, B12- or folate-deficient. More than two-thirds were anemic.

The researchers noted an overall increase in weight by 60 g in the B12 and folate groups and by 120 grams in the combined groups, compared to the placebo group. The corresponding height increases were 7 cm, 20 cm, and 35 cm respectively. Only the weight for age increase was significant overall (WAZ score increase 0.07). Folate supplements only had a significant effect on growth of children with previous folate deficiency.

However, vitamin B12 supplements resulted in a significant (p<0.05) improvement in weight-for-age Z scores and height-for-age Z scores among the children who were stunted (WAZ 0.2, HAZ 0.2), underweight (WAZ 0.15, HAZ 0.1), or wasted (WAZ, HAZ 0.3).

Other micronutrient deficiencies may have attenuated the effects of B12 and folate supplementation, the researchers caution.

"We provide evidence that folate and vitamin B-12 are growth-limiting nutrients in this population," the researchers concluded.

"Our findings should be verified in other settings and in studies specifically designed to measure the impact on growth," Dr. Strand concluded.

Thrasher Research Fund, the Research Council of Norway, and the South-Eastern Norway Regional Health Authority supported this research. The authors made no disclosures.

Source: http://bit.ly/1afj5rI

Pediatrics 2015

(c) Copyright Thomson Reuters 2015. Click For Restrictions - http://about.reuters.com/fulllegal.asp