title: Multiple micronutrient supplementation improves vitamin B₁₂ and folate concentrations of HIV infected children in Uganda: a randomized controlled trial.
abstract: BACKGROUND
  The effect of multiple micronutrient supplementation on vitamin B₁₂ and folate has hither to not been reported in African HIV infected children. This paper describes vitamin B₁₂ and folate status of Ugandan HIV infected children aged 1-5 years and reports the effect of multiple micronutrient supplementation on serum vitamin B12 and folate concentrations.
  
  
  METHODS
  Of 847 children who participated in a multiple micronutrient supplementation trial, 214 were assessed for vitamin B₁₂ and folate concentrations pre and post supplementation. One hundred and four children were randomised to two times the recommended dietary allowance (RDA) of a 14 multiple micronutrient supplement (MMS) and 114 to a 'standard of care' supplement of 6 multivitamins (MV). Serum vitamin B12 was measured by an electrochemiluminescence immunoassay and folate by a competitive protein-binding assay using Modular E (Roche) automatic analyzer. Vitamin B₁₂ concentrations were considered low if less than 221 picomoles per litre (pmol/L) and folate if < 13.4 nanomoles per litre (nmol/L). The Wilcoxon Signed Ranks test was used to measure the difference between pre and post supplementation concentrations.
  
  
  RESULTS
  Vitamin B₁₂ was low in 60/214 (28%) and folate in 62/214 (29.0%) children. In the MMS group, the median concentration (IQR) of vitamin B₁₂ at 6 months was 401.5 (264.3 - 518.8) pmol/L compared to the baseline of 285.5 (216.5 - 371.8) pmol/L, p < 0.001. The median (IQR) folate concentrations increased from 17.3 (13.5-26.6) nmol/L to 27.7 (21.1-33.4) nmol/L, p < 0.001. In the 'standard of care' MV supplemented group, the median concentration (IQR) of vitamin B₁₂ at 6 months was 288.5 (198.8-391.0) pmol/L compared to the baseline of 280.0 (211.5-386.3) pmol/L while the median (IQR) folate concentrations at 6 months were 16.5 (11.7-22.1) nmol/L compared to 15.7 (11.9-22.1) nmol/L at baseline. There was a significant difference in the MMS group in both vitamin B₁₂ and folate concentrations but no difference in the MV group.
  
  
  CONCLUSIONS
  Almost a third of the HIV infected Ugandan children aged 1-5 years had low serum concentrations of vitamin B₁₂ and folate. Multiple micronutrient supplementation compared to the 'standard of care' supplement of 6 multivitamins improved the vitamin B12 and folate status of HIV infected children in Uganda.
  
  
  BACKGROUND
  http://ClinicalTrials.govNCT00122941).
authors: Department of Paediatrics and Child Health, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda. gracendeezi@yahoo.com
authors: Grace
authors: G
authors: Ndeezi
authors: James K
authors: JK
authors: Tumwine
authors: Christopher M
authors: CM
authors: Ndugwa
authors: Bjørn J
authors: BJ
authors: Bolann
authors: Thorkild
authors: T
authors: Tylleskär
references: Pediatrics. 2010 Jul;126(1):e140-9
references: 20547647
references: Arch Intern Med. 1989 Sep;149(9):2039-41
references: 2774781
references: Ann Trop Paediatr. 2002 Mar;22(1):19-23
references: 11926045
references: Am J Clin Nutr. 2007 Nov;86(5):1302-9
references: 17991639
references: BMC Pediatr. 2010 Sep 21;10:68
references: 20858275
references: Am J Clin Nutr. 2007 Apr;85(4):1127-33
references: 17413115
references: J Trop Pediatr. 2010 Feb;56(1):27-35
references: 19502599
references: J Acquir Immune Defic Syndr. 2006 Aug 15;42(5):523-8
references: 16868496
references: Am J Clin Nutr. 2003 Feb;77(2):433-40
references: 12540405
references: Pediatrics. 1998 Oct;102(4 Pt 1):913-23
references: 9755265
references: Clin Chem. 2003 Dec;49(12):2067-75
references: 14633879
references: Trop Doct. 2009 Apr;39(2):83-5
references: 19299288
references: Am J Hematol. 1994 Nov;47(3):167-71
references: 7942779
references: Eur J Clin Invest. 2001 Nov;31(11):992-8
references: 11737242
references: Semin Hematol. 1999 Jan;36(1):75-87
references: 9930570
references: J Nutr. 1997 Feb;127(2):345-51
references: 9039838
references: Eur J Clin Nutr. 1993 Nov;47(11):803-7
references: 8287850
references: Eur J Clin Nutr. 2005 Aug;59(8):960-8
references: 15956998
references: AIDS. 1995 Sep;9(9):1051-6
references: 8527077
references: Int J STD AIDS. 2004 Feb;15(2):127-33
references: 15006076
references: J Nutr. 2003 Nov;133(11 Suppl 2):3972S-3980S
references: 14672298
references: AIDS. 2009 Jan 28;23(3):403-7
references: 19114857
references: Am J Clin Nutr. 2003 Apr;77(4):891-8
references: 12663288
references: Nutr Res. 2009 Oct;29(10):716-22
references: 19917451
references: Eur J Clin Nutr. 2005 Sep;59(9):1064-70
references: 16015269
references: Am J Clin Nutr. 1995 Nov;62(5):1013-9
references: 7572725
references: J Trop Pediatr. 2005 Dec;51(6):356-61
references: 15947011
references: Hematology Am Soc Hematol Educ Program. 2003;:62-81
references: 14633777
references: Acta Paediatr. 2009 Jan;98(1):98-102
references: 18945280
references: J Nutr. 2010 Jun;140(6):1146-54
references: 20410083