Cobalamin and folate status in malnourished children

Suresh Goyal, Kavita Tiwari, Pradeep Meena, Sunny Malviya, Mohd. Asif


Background: Vitamin B12 and folate are essential micronutrients which are critical especially during infancy and early childhood as these are periods of rapid growth, development, and increased demand. Malnutrition further increases the risk of these micronutrient deficiency due to poor socioeconomic status, inadequate intake and poor absorption. Aim of present work was to study the cobalamin and folate status in malnourished children.

Methods: A hospital based observational study on 80 children suffering from severe acute malnutrition (SAM) aged 6-60 months. Detailed socio-economic, feeding and development history with complete anthropometric evaluation was done. Blood samples sent for measurement of plasma vitamin B12 and serum folate levels. Statistical analysis was done using SPSS version 20.0.

Results: Mean age of SAM children was 17.25±12.60 months. 30 (37.5%) had vitamin B12 deficiency (vitamin B12 levels<100pg/ml) and 9 (11.25%) had borderline vitamin B12 levels (100-200pg/ml). Folate deficiency was found in only 7 (8.75%) children. Mean vitamin B12 and folate levels were found to be 353.65±330.76pg/ml, 11.18±4.17ng/ml respectively. Among vitamin B12 deficient children, majority (26, 86.66%) belong to lower socio-economic status, 17 (56.66%) were still predominantly on breast feeding and 11 (36.66%) had delayed introduction of complementary feeding. Among B12 deficient children 23 (76.66%) had delayed development (DQ <70). 100% of B12 deficient children were anemic with majority (21,70%) having severe anemia. 17 (56.66%) B12 deficient children also had associated thrombocytopenia (PC <1.5 lakh/cumm).

Conclusions: There was a high prevalence of vitamin B12 deficiency among malnourished children. Folate deficiency was found only in few. Efforts should be directed to prevent its deficiency in pregnant and breastfeeding women and their infants with special attention on malnourished children.


Folate deficiency, Malnutrition, Vitamin B12 deficiency

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Rasmussen SA, Fernhoff PM, Scanlon KS. Vitamin B12 deficiency in children and adolescents. J. Pediatr. 2001;138:10-17.

Matoth Y, Zehavi I, Topper E, Klein T. Folate nutrition and growth in infancy. Arch Dis Child. 1979;54:699-702.

Black MM. Effects of vitamin B12 and folate deficiency on brain development in children. Food Nutr Bull. 2008;29(Suppl. 1):S126-S131.

Allen LH. Causes of vitamin B12 and folate deficiency. Food Nutr Bull. 2008;29 (Suppl 1):S20-S34.

Allen LH. Nutrient Regulation during Pregnancy, Lactation, and Infant Growth. Vitamin B12 metabolism and status during pregnancy, lactation and infancy. Springer; New York, NY, USA;1994:173-186.

Carmel R. Discussion: Causes of vitamin B. Folate Vitam B. 2008;29: S35-S37.

Ministry of Health and Family Welfare Government of India. Nutrition in India. National Family Health Survey (NFHS-3) India 2005-06. Available at

Ministry of Health and Family Welfare. Government of India. National Family Health Survey – 4, 2015 -16. India Fact Sheet. Available at

Ministry of Health and Family Welfare. Government of India. National Family Health Survey – 4, 2015 -16. District Level Household Survey. Available at

Lerner NB. Megaloblastic anemia. In: Diseases of blood. Kliegman RM, Stanton BF, St. Geme JW, Schor NF. Nelson Textbook of Pediatrics. 20th ed. Elsevier Publishers. 2016;2:2321-2.

Hoffbrand AV. Megaloblastic anemia. Hematopoietic disorders. Kasper DL, Hauser SL, Jameson JL, Fauci AS, Longo DL, Loscalzo J. Harrison’s principles of internal medicine. 19th ed. McGraw-Hi11 Education. 2015;1:640-7.

Sachdev HPS, Shah D. Vitamin B complex deficiencies and excess. Kliegman RM, Stanton BF, St. Geme JW, Schor NF. Nelson Textbook of Pediatrics. 20th ed. Elsevier Publishers. 2016;1:327-8.

WHO Child Growth Standards - World Health Organization. Available at

Agarwal R, Sankhyan N, Jain V. Normal growth and its disorders. Paul VK, Bagga A. GHAI Essential Pediatrics. 8th Ed. CBS Publishers; 2013:11-25.

Yadav SS, Yadav ST, Mishra P, Mittal A, Kumar R, and Singh J. An epidemiological study of malnutrition among under five children of rural and urban Haryana. J Clin Diagn Res. 2016;10:LC07-LC10.

Chhabra A, Chandar V, Gupta A, Chandra H. Megaloblastic anaemia in hospitalised children. JIACM. 2012;13: 195-7

Yaikhomba T, Poswal L, Goyal S. Assessment of iron, folate and vitamin B12 status in severe acute malnutrition. Indian J Pediatr. 2015;82:511-4