Diarrhea and Novel Dietary Factors Emerge as Predictors of Serum Vitamin B12 in Panamanian Children

Abstract

Background The role of gastrointestinal infection as a factor determining vitamin B12 status in populations with low intake of animal-source foods is unclear. Objective To determine dietary adequacy and serum concentrations of vitamin B12 in an extremely impoverished indigenous population of Panamanian children aged 12 to 60 months, and to identify predictors of both dietary and serum vitamin B12. Methods A previous community-based survey provided the usual dietary intake and personal, household, and infection (Ascaris and diarrheal disease) information for 209 weaned children. Serum vitamin B12 was assayed using electrochemiluminescence for 65 of these children. Children with adequate or inadequate dietary vitamin B12 intake were compared, and predictors of dietary and serum vitamin B12 were identified using step-wise regression analyses of one index child per household. Results Dietary vitamin B12 intake was inadequate in 43% of children; these children were poorer, had less frequent diarrhea, and obtained a higher percentage of their energy from carbohydrate than children with adequate intake. Energy intake positively predicted dietary vitamin B12 intake. In contrast, serum vitamin B12 concentrations were normal in all but 3% of the children. Serum vitamin B12 was positively associated with weekly servings of fruit, corn-based food, and ñame (a traditional starchy food), but not with animal-source foods. Finally, serum vitamin B12 was not associated with Ascaris intensity but was lowered with increasing frequency of diarrhea. Conclusions Although inadequate dietary intake of vitamin B12 was common, most serum values were normal. Nevertheless, diarrheal disease emerged as a negative predictor of serum vitamin B12 concentration.