Poster Topical Area: Maternal, Perinatal and Pediatric Nutrition

Location: Hall D

Poster Board Number: 280

P13-022 - Cobalamin and folate status among breastfed infants in Bhaktapur, Nepal

Sunday, Jun 10
8:00 AM – 6:00 PM


The objectives of this study are to explore cobalamin and folate status and describe its determinants among breastfed infants of 6-11 months residing in Bhaktapur municipality of Nepal.


We collected plasma samples from 6-11 months-old breastfed infants with a length-for-age of z-score less than -1 and analyzed plasma for folate, cobalamin, methylmalonic acid (MMA) and total homocysteine (tHcy) concentrations. We also calculated a combined indicator of cobalamin (3cB12) because individual biomarkers of cobalamin have their limitations in terms of sensitivity or specificity. Multiple linear regression analyses were done to explore socio-demographic and nutritional characteristics associated with 3cB12.


Among total 316 infants, marginal cobalamin deficiency (plasma cobalamin 148-221 pmol/L) was found in 24% whereas 11% were cobalamin deficient (plasma cobalamin <148 pmol/L). Based on 3cB12, 58% had poor cobalamin status. Elevated total homocysteine (>10 µmol/L) or methylamlonic acid (>0.28 µmol/L) were found among 53% and 75% infants, respectively. However, folate deficiency (<10 nmol/L) was not found in this population as the lowest value of plasma folate was 20.7 nmol/L. The 3cB12 increased with increasing age of the infants in the unadjusted regression analysis. Being born at low birth weight, exclusively breastfeeding for at least 3 months, and stunting were associated with lower 3cB12. Except for ownership of own residence, none of other variables were associated with 3cB12 when we adjusted for possible confounding variables


More than 50% of the infants had poor cobalamin status, which is probably due to sub-optimal maternal status and the predominantly vegetarian complementary feeding. The consequences of poor cobalamin status should be a prioritized research question and strategies to improve maternal and child status should be considered.

Funding Source: Thrasher Research Fund

CoAuthors: Manjeswori Ulak – Child Health Research Project; Mari Hysing – Uni Research Health, Bergen, Norway; Ingrid Kvestad – Uni Research Health, Bergen, Norway; Merina Shrestha – Institute of Medicine; Suman Ranjitkar – Child Health Research Project; Laxman Shrestha – Institute of Medicine; Tor Strand – University of Bergen, Norway

Ram KRISHNA.. Chandyo

Ass Professor
Kathmandu Medical College
Bhaktapur, Bagmati, Nepal