Vitamin B-12 status in infancy is positively associated with development and cognitive functioning 5 y later in Nepalese children.
Background:Poor vitamin B-12 (cobalamin) status is widespread in South Asia. Insufficient vitamin B-12 status has been linked to poor neurodevelopment in young children.Objective:We measured the associations between vitamin B-12 status in infancy (2-12 mo) and the development and cognitive functioning in Nepalese children 5 y later.Design:Vitamin B-12 status was assessed in infancy with the use of plasma cobalamin, total homocysteine (tHcy), and methylmalonic acid (MMA). At 5 y of age, we measured development with the use of the Ages and Stages Questionnaire, 3rd edition (ASQ-3), and cognitive functioning by using the Developmental Neuropsychological Assessment, 2nd edition (NEPSY II), in 320 children. In regression models, we estimated the associations between vitamin B-12 status, including a combined indicator of vitamin B-12 status (3cB12) and scores on the ASQ-3 and NEPSY II subtests.Results:All markers of vitamin B-12 status with the exception of plasma cobalamin were significantly associated with the total ASQ-3 scores in the multiple regression models. A 1-unit increase in the 3cB12 score was associated with an increase in the total ASQ-3 score of 4.88 (95% CI: 2.09, 7.68;P= 0.001). Increases in both plasma tHcy and MMA (indicating poorer status) were associated with a decrease in scores on the NEPSY II affect recognition and geometric puzzle subtests. Each unit increment in 3cB12 scores was associated with increases of 0.82 (95% CI: 0.49, 1.14;P< 0.0005), 0.59 (95% CI: 0.10, 1.09;P= 0.020), and 0.24 (95% CI: 0.02, 0.47;P= 0.035) in the affect recognition, geometric puzzle, and block construction scores, respectively.Conclusions:Vitamin B-12 status in infancy is associated with development and performance on social perception tasks and visuospatial abilities at 5 y of age. The long-term effects of poor vitamin B-12 status in infancy need further investigation in randomized controlled trials.
Regional Center for Child and Youth Mental Health and Child Welfare, West, Uni Research Health, Bergen, Norway.
Ingrid
I
Kvestad
Regional Center for Child and Youth Mental Health and Child Welfare, West, Uni Research Health, Bergen, Norway.
Mari
M
Hysing
Department of Child Health, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Merina
M
Shrestha
Department of Child Health, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Manjeswori
M
Ulak
Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.|WorldFish, Penang, Malaysia.|Departments of Global Health and Population, Nutrition, and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
Andrew L
AL
Thorne-Lyman
College of Applied Sciences, Oslo and Akershus University, Oslo, Norway.
Sigrun
S
Henjum
Department of Clinical Science and.|Laboratory of Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway.
Per M
PM
Ueland
Bevital AS, Bergen, Norway; and.
Øyvind
Ø
Midttun
Departments of Global Health and Population, Nutrition, and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
Wafaie
W
Fawzi
Department of Child Health, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Ram K
RK
Chandyo
Department of Child Health, Tribhuvan University Teaching Hospital, Kathmandu, Nepal.
Prakash S
PS
Shrestha
Center for Intervention Studies in Maternal and Child Health, University of Bergen, Bergen, Norway; tor.strand@uib.no.|Division for Research, Innlandet Hospital Trust, Lillehammer, Norway.
Tor A
TA
Strand
D000328:Adult; D001208:Asia; D002657:Child Development; D003071:Cognition; D060825:Cognitive Dysfunction / Q000097:blood / Q000209:etiology*; D005260:Female; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007223:Infant; D008297:Male; D008764:Methylmalonic Acid / Q000097:blood; D009390:Nepal; D065886:Neurodevelopmental Disorders / Q000097:blood / Q000209:etiology*; D009483:Neuropsychological Tests; D009752:Nutritional Status; D014805:Vitamin B 12 / Q000097:blood*; D014806:Vitamin B 12 Deficiency / Q000097:blood / Q000150:complications*; D055815:Young Adult
D006710:Homocysteine; D008764:Methylmalonic Acid; D014805:Vitamin B 12
children; cognition; low-income countries; neurodevelopment; vitamin B12