Cobalamin and folate status predicts mental development scores in North Indian children 12–18 mo of age

• Published in: The American journal of clinical nutrition 2013-02, Vol.97 (2), p.310-317
• Main Authors: Strand, Tor A, Taneja, Sunita, Ueland, Per M, Refsum, Helga, Bahl, Rajiv, Schneede, Joern, Sommerfelt, Halvor, Bhandari, Nita
• Format: Article
• Language: English
• Subjects: Ability tests; Biological and medical sciences; Biomarkers; Biomarkers - blood; blood sampling; Child Development; children; clinical nutrition; cognition; Cognition & reasoning; Cognition Disorders - blood; Cognition Disorders - epidemiology; Cognition Disorders - etiology; Cognition Disorders - prevention & control; Cohort Studies; Developmental Disabilities - epidemiology; Developmental Disabilities - etiology; Developmental Disabilities - prevention & control; Feeding. Feeding behavior; Female; folic acid; Folic Acid - administration & dosage; Folic Acid - blood; Folic Acid - therapeutic use; Folic Acid Deficiency - epidemiology; Folic Acid Deficiency - physiopathology; Folic Acid Deficiency - prevention & control; Fundamental and applied biological sciences. Psychology; homocysteine; Homocysteine - blood; Humans; India - epidemiology; Infant; infant development; Male; methylmalonic acid; Methylmalonic Acid - blood; Neurogenesis; nutrients; Nutritional Status; Pediatrics; Plasma; Prevalence; Psychomotor Performance; regression analysis; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vitamin B; Vitamin B 12 - administration & dosage; Vitamin B 12 - blood; Vitamin B 12 - therapeutic use; Vitamin B 12 Deficiency - epidemiology; Vitamin B 12 Deficiency - physiopathology; Vitamin B 12 Deficiency - prevention & control; vitamin B12; Vitamin deficiency
• ISSN: 0002-9165; 1938-3207; 1938-3207
• DOI: 10.3945/ajcn.111.032268

Background: Micronutrient deficiencies can affect cognitive function. Many young children in low- and middle-income countries have inadequate cobalamin (vitamin B-12) status.Objective: The objective was to measure the association of plasma concentrations of folate, cobalamin, total homocysteine, and methylmalonic acid with cognitive performance at 2 occasions, 4 mo apart, in North Indian children aged 12–18 mo.Design: Bayley Scales of Infant Development II were used to assess cognition. In multiple regression models adjusted for several potential confounders, we measured the association between biomarkers for folate and cobalamin status and psychomotor or mental development scores on the day of blood sampling and 4 mo thereafter.Results: Each 2-fold increment in plasma cobalamin concentration was associated with a significant increment in the mental development index score of 1.3 (95% CI: 0.2, 2.4; P = 0.021). Furthermore, each 2-fold increment in homocysteine or methylmalonic acid concentration was associated with a decrement in mental development index score of 2.0 (95% CI: 0.5, 3.4; P = 0.007) or 1.1 (95% CI: 0.3, 1.8; P = 0.004) points, respectively. Plasma folate concentration was significantly and independently associated with mental development index scores only when children with poor cobalamin status were excluded, ie, in those who had cobalamin concentrations below the 25th percentile. None of these markers was associated with psychomotor scores in the multiple regression models.Conclusions: Cobalamin and folate status showed a statistically significant association with cognitive performance. Given the high prevalence of deficiencies in these nutrients, folate and cobalamin supplementation trials are required to measure any beneficial effect on cognition. The study was registered at www.clinicaltrials.gov under the identifier number NCT00272116.