Vitamin Status among Breastfed Infants in Bhaktapur, Nepal

Abstract

Vitamin deficiencies are known to be common among infants residing in low- and middle-income countries but relatively few studies have assessed several biochemical parameters simultaneously. The objective of the study was to describe the status of vitamins (A, D, E, B₆, B12 and folate) in breastfed infants. We measured the plasma concentrations of trans retinol, 25 hydroxy vitamin D, α-tocopherol, pyridoxal 5'-phosphate, cobalamin, folate, methylmalonic acid, homocysteine, hemoglobin and C-reactive protein from 467 randomly selected infants. One in five (22%) was deficient in at least one vitamin. Mean (SD) plasma folate concentration was 73 (35) nmol/L, and no infant in the sample was folate deficient. Vitamin B₆ deficiency and vitamin B12 deficiency was found in 22% and 17% of the infants, respectively. Elevated plasma methylmalonic acid or total homocysteine concentration was found in 82% and 62% of infants, respectively. Fifteen percent of infants were vitamin A deficient and 65% were marginally deficient in vitamin A. Fewer than 5% of infants had low plasma vitamin D concentration or vitamin E concentration (α-tocopherol <9.3 µmol/L). Our results illustrate the importance of continued supplementation campaigns and support the expansion of food fortification and dietary diversification programs that target children and women in Nepal.

Keywords: Nepal; homocysteine; infant; methylmalonic acid; vitamins.

Figure 1

Association between vitamins of B₆(pyridoxal 5′ phosphate nmol/L), E(α-tocopherol, µmol/L), D(25(OH)D, nmol/L), A(trans retinol, µmol/L) , B₁₂(cobalamin, pmo/L), Folate(plasma folate, nmol/L), MMA(µmol/L) and tHcy(µmol/L) with age among 467 breastfed Nepalese infants. The Y axis indicate the mean concentration of plasma vitamins or metabolic markers. X axis indicate the age of the child. The shaded area represents 95% CI of the plasma vitamins and metabolic markers.