Serum cobalamin in children with moderate acute malnutrition in Burkina Faso: Secondary analysis of a randomized trial

Abstract

Background Among children with moderate acute malnutrition (MAM) the level of serum cobalamin (SC) and effect of food supplements are unknown. We aimed to assess prevalence and correlates of low SC in children with MAM, associations with hemoglobin and development, and effects of food supplements on SC. Methods and findings A randomized 2 × 2 × 3 factorial trial was conducted in Burkina Faso. Children aged 6 to 23 months with MAM received 500 kcal/d as lipid-based nutrient supplement (LNS) or corn–soy blend (CSB), containing dehulled soy (DS) or soy isolate (SI) and 0%, 20%, or 50% of total protein from milk for 3 months. Randomization resulted in baseline equivalence between intervention groups. Data on hemoglobin and development were available at baseline. SC was available at baseline and after 3 and 6 months. SC was available from 1,192 (74.1%) of 1,609 children at baseline. The mean (±SD) age was 12.6 (±5.0) months, and 54% were females. Low mid-upper arm circumference (MUAC; Conclusions Low SC is prevalent among children with MAM and may contribute to impaired erythropoiesis and child development. The SC increase during supplementation was inadequate. The bioavailability and adequacy of cobalamin in food supplements should be reconsidered. Trial registration ISRCTN Registry ISRCTN42569496. Henrik Friis and colleagues, investigate the prevalence and correlates of low serum cobalamin, associations with hemoglobin and child development, and associations of serum cobalamin levels with food supplementation in children moderate acute malnutrition in Burkina Faso. Author summary Why was this study done? We searched PubMed since 2000 using the terms (severe malnutrition OR acute malnutrition OR marasmus OR kwashiorkor OR wasting) AND (cobalamin OR B12) AND child*). We found no studies among children with moderate acute malnutrition (MAM) or severe acute malnutrition (SAM) treated with recommended food aid products and with data on serum cobalamin (SC) before and after treatment. What did the researchers do and find? We found that two-thirds of children with MAM had marginal or low SC, which were associated with deficits in hemoglobin and child development scores. The content of cobalamin in the food aid products was in accordance with the World Health Organization (WHO)’s recommendation and the duration of supplementation, 3 months, much longer than in programs. Despite this, one-third still had marginal or low SC at the end of supplementation, and mean levels declined considerable in the subsequent 3 months. While the study showed that supplementation was inadequate in terms of normalizing cobalamin status, it showed that lipid-based nutrient supplement (LNS) based on soy isolate (SI) was the best. What do these findings mean? Cobalamin is important for erythropoiesis and brain development. It is also likely to be of pivotal importance in the development of malnutrition, given its role in enterocyte turnover and, hence, absorption. Millions of children are treated for acute malnutrition every year. It is important that these children not only survive, but also get enough cobalamin to support key functions and long-term development.