A study of clinical spectrum of vitamin B12 deficiency in pediatric age group in a tertiary care hospital
DOI:
https://doi.org/10.18203/2349-3291.ijcp20250765Keywords:
Vegetarian diet, Malnutrition, Developmental delays, Maternal vitamin B12 levelsAbstract
Background: Vitamin B12 deficiency is a major preventable issue in children, often leading to severe neurological and hematological problems. In regions with high vegetarianism and malnutrition, it remains underreported. This study aims to examine the clinical manifestations and contributing factors of vitamin B12 deficiency in affected children.
Methods: This cross-sectional survey at Basaveshwar Teaching and General Hospital and Sangameshwar Teaching and General Hospital, attached to Mahadevappa Rampure Medical College and Private Hospitals in Kalaburagi, from August 2022 to January 2024 included 75 children (0-18 years) with vitamin B12 deficiency. Data collection involved dietary patterns, appetite, neurological symptoms, and co-morbid conditions. Laboratory investigations assessed hemoglobin, peripheral smear, vitamin B12 levels, and platelet count. Informed consent was obtained from all participants' guardians.
Results: The study of 75 cases revealed a mean age of 6.16 years, with 37.3% under 1 year, 36% adolescents, and 20% aged 1-4 years. Vitamin B12 deficiency was widespread, affecting 85.3% with levels ≤200 pmol/l. A vegetarian diet was significantly associated with higher deficiency rates (p<0.05). Significant nutritional deficiencies and comorbidities were observed, including developmental delays and anemia. Lower vitamin B12 levels correlated with increased malnutrition severity (p=0.001).
Conclusions: This study highlights the critical role of vitamin B12 in maintaining health among children and adolescents. It reveals high deficiency rates, particularly in infants, those with delayed complementary feeding, and vegetarians. Maternal vitamin B12 levels significantly impact breastfed infants' health. An inverse correlation between vitamin B12 levels and nutritional status emphasizes the need for early detection, monitoring, and intervention.
Metrics
References
Courtney D, Thornberg. Vitamin B12 deficiency. Nelson Textbook of Pediatrics, Volume 2. 21st Edition. Elsevier Saunders: Philadelphia, PA, USA. 2020;2517-21.
Gupta P, Menon PSN, Ramji S, Lodha R. PG Textbook of Pediatrics: Volume 2: Infections and Systemic Disorders. JP Medical Ltd. 2015.
World Health Organization. 2008.
Doets EL, In 't Veld PH, Szczecińska A, Dhonukshe-Rutten RA, Cavelaars AE, van 't Veer P, et al. A systematic review on daily vitamin B12 losses and bioavailability for deriving recommendations on vitamin B12 intake with the factorial approach. Ann Nutr Metab. 2013;62:311-22. DOI: https://doi.org/10.1159/000346968
Allen LH. Bioavailability of vitamin B12. Int J Vitam Nutr Res. 2010;80:330-5. DOI: https://doi.org/10.1024/0300-9831/a000041
Vogiatzoglou A, Smith AD, Nurk E, Berstad P, Drevon CA, Ueland PM, et al. Dietary sources of vitamin B-12 and their association with plasma vitamin B-12 concentrations in the general population: the Hordaland Homocysteine Study. Am J Clin Nutr. 2009;89:1078-87. DOI: https://doi.org/10.3945/ajcn.2008.26598
Wirthensohn M, Wehrli S, Ljungblad UW, Huemer M. Biochemical, Nutritional, and Clinical Parameters of Vitamin B12 Deficiency in Infants: A Systematic Review and Analysis of 292 Cases Published between 1962 and 2022. Nutrients. 2023;15(23):4960. DOI: https://doi.org/10.3390/nu15234960
Bailey RL, West KP, Black RE. The role of vitamin B12 in human health and disease. J Nutr. 2015;145(7):1480-8.
Finkelstein JD, Martin JJ, Stabler SP, Allen RH. Vitamin B12 deficiency in the elderly: a review of the literature. J Nutr. 2000;130(6):1673-8.
Rasmussen SA, Fernhoff PM, Scanlon KS. Vitamin B12 deficiency in children and adolescents. Pediatrics. 2001;107(5):1218-20. DOI: https://doi.org/10.1067/mpd.2001.112160
Jain R, Singh A, Mittal M, Talukdar B. Vitamin B12 deficiency in children: a treatable cause of neurodevelopmental delay. J Child Neurol. 2015;30(5):641-3. DOI: https://doi.org/10.1177/0883073813516194
Chandra J, Dewan P, Kumar P, Mahajan A, Singh P, Dhingra B, et al. Diagnosis, treatment and prevention of nutritional anemia in children: recommendations of the joint committee of pediatric hematology-oncology chapter and pediatric and adolescent nutrition society of the Indian Academy of Pediatrics. Indian Pediatr. 2022;59(10):782-801. DOI: https://doi.org/10.1007/s13312-022-2622-2
Gupta R, Rawat AK, Singh P, Gupta J, Pathak A. Infantile tremor syndrome: current perspectives. Res Rep Trop Med. 2019;10:103-8. DOI: https://doi.org/10.2147/RRTM.S180604
Umasanker S, Bhakat R, Mehta S, Rathaur VK, Verma PK, Bhat NK, et al. Vitamin B12 deficiency in children from Northern India: Time to reconsider nutritional handicaps. J Fam Med Prim Care. 2020;9(9):4985. DOI: https://doi.org/10.4103/jfmpc.jfmpc_712_20
Shalini T, Pullakhandam R, Ghosh S, Kulkarni B, Rajkumar H, Sachdev HS, et al. Prevalence of Vitamin B12 and Folate Deficiencies in Indian Children and Adolescents. Nutrients. 2023;15(13):3026. DOI: https://doi.org/10.3390/nu15133026
Goyal S, Tiwari K, Meena P, Malviya S, Mohd A. Cobalamin and folate status in malnourished children. Int J Contemp Pediatr. 2017;4:1480-4. DOI: https://doi.org/10.18203/2349-3291.ijcp20172690
Goraya JS, Kaur S. Infantile tremor syndrome -- down but not out. Indian Pediatr. 2015;52(3):249-50. DOI: https://doi.org/10.1007/s13312-015-0619-9
Ministry of Health and Family Welfare - Government of India. Comprehensive national nutritional survey, 2016-2018. Available at: https://nhm.gov.in/WriteReadData/l892s/1405796031571201348.pdf. Accessed on 25 January 2025.