title: Cobalamin and folate status in 6 to 35 months old children presenting with acute diarrhea in Bhaktapur, Nepal.
abstract: BACKGROUND
  Cobalamin and folate are essential micronutrients and are important in DNA and RNA synthesis, cell proliferation, growth, hematopoiesis, and cognitive function. However, data on cobalamin and folate status are lacking particularly from young children residing in low and middle income countries.
  
  
  OBJECTIVE
  To measure cobalamin and folate status and identifies their predictors among 6 to 35 months old children presenting with acute diarrhea.
  
  
  METHODS
  This was a cross-sectional study in 823 children presenting with acute diarrhea. We measured plasma cobalamin, folate, methylmalonic acid and total homocysteine who sought treatment for acute diarrhea between June 1998 and August 2000.
  
  
  RESULTS
  The mean (SD) plasma concentrations of cobalamin, folate, total homocysteine and methylmalonic acid were 206 (124) pmol/L, 55 (32) nmol/L, 11.4 (5.6) µmol/L and 0.79 (1.2) µmol/L, respectively. The prevalence of low plasma cobalamin (<150 pmol/L) was 41% but less than 2% (15) children had low folate concentration (<10 nmol/L). Plasma homocysteine and methylmalonic acid concentrations were negatively associated with cobalamin concentration but not associated with folate status. The prevalence of cobalamin deficiency was higher in breastfed than non-breastfed children (44% vs 24%; p = <0.001). The prevalence of hyperhomocysteinemia (>10 µmol/L) and elevated methylmalonic acid (>0.28 µmol/L) were 73% and 52%, respectively. In the regression analyses, the plasma cobalamin concentration was positively associated with age, and introduction of animal or formula milk.
  
  
  CONCLUSIONS
  Our study indicated that poor cobalamin status was common particularly among breastfed children. Folate deficiency was virtually none existent. Possible consequences of cobalamin deficiency in young children need to be explored.
authors.affiliation: Centre for International Health, University of Bergen, Norway; Department of Child Health, Institute of Medicine, Kathmandu, Nepal.
authors.forename: Manjeswori
authors.initials: M
authors.lastname: Ulak
authors.affiliation: Centre for International Health, University of Bergen, Norway; Community Medicine, Kathmandu Medical College, Nepal.
authors.forename: Ram K
authors.initials: RK
authors.lastname: Chandyo
authors.affiliation: Department of Pediatrics, Kathmandu Medical College, Nepal.
authors.forename: Ramesh K
authors.initials: RK
authors.lastname: Adhikari
authors.affiliation: Department of Pediatrics, Kathmandu Medical College, Nepal.
authors.forename: Pushpa R
authors.initials: PR
authors.lastname: Sharma
authors.affiliation: Centre for International Health, University of Bergen, Norway.
authors.forename: Halvor
authors.initials: H
authors.lastname: Sommerfelt
authors.affiliation: Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Norway.
authors.forename: Helga
authors.initials: H
authors.lastname: Refsum
authors.affiliation: Centre for International Health, University of Bergen, Norway; Medical Microbiology, Innlandet Hospital Trust, Lillehammer, Norway.
authors.forename: Tor A
authors.initials: TA
authors.lastname: Strand
mesh_terms: D000208:Acute Disease; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000097:blood* / Q000453:epidemiology; D005260:Female; D005492:Folic Acid / Q000097:blood*; D006801:Humans; D007223:Infant; D008297:Male; D009390:Nepal / Q000453:epidemiology; D014805:Vitamin B 12 / Q000097:blood*
chemical_list: D005492:Folic Acid; D014805:Vitamin B 12