title: Vitamin B-12, folate, iron, and vitamin A concentrations in rural Indian children are associated with continued breastfeeding, complementary diet, and maternal nutrition.
abstract: BACKGROUND
  Determinants of vitamin B-12, folate, iron, and vitamin A concentrations in young children in rural south Asia are poorly understood. These micronutrients are crucial for the production of hemoglobin and have other important physiologic functions.
  
  
  OBJECTIVE
  We sought to develop explanatory models for concentrations of vitamin B-12, folate, ferritin, and retinol binding protein (RBP) in children aged between 1 and 2 y in rural Karnataka, India.
  
  
  METHODS
  We performed a cross-sectional study in 12-23-mo-old toddlers who lived in 2 rural districts of Karnataka, India. For each child, data concerning dietary, food-security, and sociodemographic and maternal factors were obtained, and serum vitamin B-12, folate, ferritin, and RBP were measured. Multiple regression and structural equation modeling were applied to determine associations with micronutrient concentrations.
  
  
  RESULTS
  Of 396 sampled children, 254 children (65.6%) had at least one micronutrient deficiency. With the use of multiple regression, continued breastfeeding was independently associated with the concentration of each micronutrient [(log) vitamin B-12: standardized coefficient of -0.30 (P < 0.001); folate: standardized coefficient of +0.20 (P < 0.001); (log) ferritin: standardized coefficient of -0.18 (P = 0.004); (log) RBP: standardized coefficient of-0.21 (P < 0.001)]. Children who continued to breastfeed received less nutrition from complementary foods and belonged to poorer families with higher food insecurity. A structural equation model for children's vitamin B-12 concentrations was developed that highlighted the interrelation between wealth, continued breastfeeding, complementary diet, and vitamin B-12 concentrations in children.
  
  
  CONCLUSIONS
  Micronutrient deficiencies are common in this population. Rural Indian children between 1 and 2 y of age who continue to breastfeed should be especially targeted during micronutrient-supplementation programs. This trial was registered in the Australian and New Zealand Clinical Trials Registry as ACTRN12611000596909.
authors.affiliation: Hematology Research Unit, Division of Molecular Medicine, St Johns National Academy of Health Sciences, Bangalore, India.
authors.forename: Sant-Rayn
authors.initials: SR
authors.lastname: Pasricha
authors.forename: Arun S
authors.initials: AS
authors.lastname: Shet
authors.forename: James F
authors.initials: JF
authors.lastname: Black
authors.forename: H
authors.initials: H
authors.lastname: Sudarshan
authors.forename: N S
authors.initials: NS
authors.lastname: Prashanth
authors.forename: Beverley-Ann
authors.initials: BA
authors.lastname: Biggs
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D005492:Folic Acid / Q000097:blood*; D006801:Humans; D007194:India; D007223:Infant; D007501:Iron / Q000097:blood*; D018977:Micronutrients / Q000172:deficiency*; D009035:Mothers; D015999:Multivariate Analysis; D012044:Regression Analysis; D012424:Rural Population; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014801:Vitamin A / Q000097:blood*; D014805:Vitamin B 12 / Q000097:blood*
chemical_list: D018977:Micronutrients; D014801:Vitamin A; D005492:Folic Acid; D007501:Iron; D014805:Vitamin B 12