Infant Serum and Maternal Milk Vitamin B-12 Are Positively Correlated in Kenyan Infant-Mother Dyads at 1-6 Months Postpartum, Irrespective of Infant Feeding Practice

Anne M Williams, Christine P Stewart, Setareh Shahab-Ferdows, Daniela Hampel, Marion Kiprotich, Beryl Achando, Audrie Lin, Clair A Null, Lindsay H Allen, Caroline J Chantry, Anne M Williams, Christine P Stewart, Setareh Shahab-Ferdows, Daniela Hampel, Marion Kiprotich, Beryl Achando, Audrie Lin, Clair A Null, Lindsay H Allen, Caroline J Chantry

Abstract

Background: Vitamin B-12 is an essential nutrient required for many functions including DNA synthesis, erythropoiesis, and brain development. If maternal milk vitamin B-12 concentrations are low, infants may face elevated risks of deficiency when exclusively breastfed.

Objective: We evaluated cross-sectional associations between infant serum vitamin B-12 concentrations and maternal milk vitamin B-12 concentrations at 1-6 mo postpartum among an unsupplemented population in rural western Kenya, and assessed biological demographic, and dietary characteristics associated with adequate infant serum vitamin B-12.

Methods: We modeled 1) infant serum vitamin B-12 using maternal milk vitamin B-12 concentration with linear regression; and 2) adequate (>220 pmol/L) infant serum vitamin B-12 using hypothesized biological, demographic, and dietary predictors with logistic regression. In both models, we used generalized estimating equations to account for correlated observations at the cluster-level.

Results: The median (quartile 1, quartile 3) infant serum vitamin B-12 concentration was 276 pmol/L (193, 399 pmol/L) and approximately one-third of infants had serum vitamin B-12 ≤220 pmol/L, indicating that they were vitamin B-12 depleted or deficient. There was a positive correlation between maternal milk and infant serum vitamin B-12 (r = 0.36, P < 0.001) and in multivariable analyses, maternal milk vitamin B-12 concentration was significantly associated with infant serum vitamin B-12 adequacy (P-trend = 0.03).

Conclusions: Despite a high prevalence (90%) of maternal milk vitamin B-12 concentrations below the level used to establish the Adequate Intake (<310 pmol/L), there was a low prevalence of infant vitamin B-12 deficiency. We found few factors that were associated with infant vitamin B-12 adequacy in this population, including infant feeding practices, although maternal vitamin B-12 status was not measured. The contribution of maternal milk to infant vitamin B-12 status remains important to quantify across populations, given that maternal milk vitamin B-12 concentration is modifiable with supplementation. This trial was registered at clinicaltrials.gov as NCT01704105.

Keywords: Kenya; breastfeeding; human milk; infant feeding; lactation; micronutrient deficiency; vitamin B-12.

© 2018 American Society for Nutrition. All rights reserved.

Figures

FIGURE 1
FIGURE 1
Kernel density plot of infant serum vitamin B-12 concentration within a subsample of the WASH Benefits, Kenya biochemical substudy (n = 176). The areas shaded black and gray represent the proportion of the population that had serum vitamin B-12 concentration <148 pmol/L (indicative of deficiency), and >148 pmol/L but <220 pmol/L (indicative of depletion), respectively. The y-axis values, density, represent the relative likelihood of vitamin B-12 concentration among this population (e.g., a density of 0.002 multiplied by 150 pmol/L = 0.3); the AUC sums to 1. WASH, Water Sanitation and Hygiene.
FIGURE 2
FIGURE 2
Relation between vitamin B-12 in infant serum and maternal milk by reported infant feeding practice among a subsample of the WASH Benefits, Kenya biochemical substudy. The correlation for the relation between infant serum vitamin B-12 and maternal milk vitamin B-12 (both expressed in pmol/L) was similar for exclusive breastfeeding (r = 0.32, n = 47) and the combined predominantly breastfeeding and mixed feeding groups (r = 0.37, n = 129). WASH, Water Sanitation and Hygiene.

References

    1. Dror DK, Allen LH. Effect of vitamin B12 deficiency on neurodevelopment in infants: current knowledge and possible mechanisms. Nutr Rev 2008;66:250–5.
    1. Institute of Medicine Dietary Reference Intakes for Thiamin, Riboflavin, Niacin, Vitamin B6, Folate, Vitamin B12, Patothenic Acid, Biotin, and Choline. Washington, DC: National Academy Press; 2011.
    1. Black MM. Effects of vitamin B12 and folate deficiency on brain development in children. Food Nutr Bull 2008;29:S126–31.
    1. Allen LH. Causes of vitamin B12 and folate deficiency. Food Nutr Bull 2008;29:S20–34; discussion S5–7.
    1. Casterline JE, Allen LH, Ruel MT. Vitamin B-12 deficiency is very prevalent in lactating Guatemalan women and their infants at three months postpartum. J Nutr 1997;127:1966–72.
    1. Specker BL, Black A, Allen L, Morrow F. Vitamin B-12: low milk concentrations are related to low serum concentrations in vegetarian women and to methylmalonic aciduria in their infants. Am J Clin Nutr 1990;52:1073–6.
    1. Siddiqua TJ, Ahmad SM, Ahsan KB, Rashid M, Roy A, Rahman SM, Shahab-Ferdows S, Hampel D, Ahmed T, Allen LH, et al.Vitamin B12 supplementation during pregnancy and postpartum improves B12 status of both mothers and infants but vaccine response in mothers only: a randomized clinical trial in Bangladesh. Eur J Nutr 2016;55:281–93.
    1. Hay G, Clausen T, Whitelaw A, Trygg K, Johnston C, Henriksen T, Refsum H. Maternal folate and cobalamin status predicts vitamin status in newborns and 6-month-old infants. J Nutr 2010;140:557–64.
    1. Herbert V. Recommended dietary intakes (RDI) of vitamin B-12 in humans. Am J Clin Nutr 1987;45:671–8.
    1. Arsenault JE, Yakes EA, Islam MM, Hossain MB, Ahmed T, Hotz C, Lewis B, Rahman AS, Jamil KM, Briwn KH. Very low adequacy of micronutrient intakes by young children and women in rural Bangladesh is primarily explained by low food intake and limited diversity. J Nutr 2013;143:197–203.
    1. Shahab-Ferdows S, Engle-Stone R, Hampel D, Ndjebayi AO, Nankap M, Brown KH, Allen LH. Regional, socioeconomic, and dietary risk factors for vitamin B-12 Deficiency differ from those for folate deficiency in Cameroonian women and children. J Nutr 2015;145:2587–95.
    1. Rosenthal J, Lopez-Pazos E, Dowling NF, Pfeiffer CM, Mulinare J, Vellozzi C, Zhang M, Lavoie DJ, Molina R, Ramirez N, et al.Folate and vitamin B12 deficiency among non-pregnant women of childbearing-age in Guatemala 2009–2010: prevalence and identification of vulnerable populations. Matern Child Health J 2015;19:2272–85.
    1. Williams AM, Chantry CJ, Young SL, Achando BS, Allen LH, Arnold BF, Colford JM Jr, Dentz HN, Hampel D, Kiprotich MC, et al.Vitamin B-12 concentrations in breast milk are low and are not associated with reported household hunger, recent animal-source food, or vitamin B-12 intake in women in rural Kenya. J Nutr 2016;146:1125–31.
    1. Neumann CG, Oace SM, Chaparro MP, Herman D, Drorbaugh N, Bwibo NO. Low vitamin B12 intake during pregnancy and lactation and low breast milk vitamin 12 content in rural Kenyan women consuming predominantly maize diets. Food Nutr Bull 2013;34:151–9.
    1. Allen LH. B vitamins in breast milk: relative importance of maternal status and intake, and effects on infant status and function. Adv Nutr 2012;3:362–9.
    1. Duggan C, Srinivasan K, Thomas T, Samuel T, Rajendran R, Muthayya S, Finkelstein JL, Lukose A, Fawzi W, Allen LH, et al.Vitamin B-12 supplementation during pregnancy and early lactation increases maternal, breast milk, and infant measures of vitamin B-12 status. J Nutr 2014;144:758–64.
    1. Hay G, Johnston C, Whitelaw A, Trygg K, Refsum H. Folate and cobalamin status in relation to breastfeeding and weaning in healthy infants. Am J Clin Nutr 2008;88:105–14.
    1. Davis RE, Icke GC, Hilton JM, Orr E. Serum thiamin, pyridoxal, cobalamin and folate concentrations in young infants. Acta Paediatr Scand 1986;75:402–7.
    1. Karademir F, Suleymanoglu S, Ersen A, Aydinoz S, Gultepe M, Meral C, Ozkaya H, Gocmen I. Vitamin B12, folate, homocysteine and urinary methylmalonic acid levels in infants. J Int Med Res 2007;35:384–8.
    1. WHO/UNICEF Global Strategy for Infant and Young Child Feeding. Geneva: World Health Organization; 2003.
    1. Torsvik IK, Ueland PM, Markestad T, Midttun O, Bjorke Monsen AL. Motor development related to duration of exclusive breastfeeding, B vitamin status and B12 supplementation in infants with a birth weight between 2000–3000 g, results from a randomized intervention trial. BMC Pediatr 2015;15:218.
    1. Roumeliotis N, Dix D, Lipson A. Vitamin B(12) deficiency in infants secondary to maternal causes. CMAJ 2012;184:1593–8.
    1. Arnold BF, Null C, Luby SP, Unicomb L, Stewart CP, Dewey KG, Ahmed T, Ashraf S, Christensen G, Clasen T, et al.Cluster-randomised controlled trials of individual and combined water, sanitation, hygiene and nutritional interventions in rural Bangladesh and Kenya: the WASH Benefits study design and rationale. BMJ Open 2013;3:e003476.
    1. Deitchler MB, Ballard T, Swindale A, Coates J. Introducing a simple measure of household hunger for cross-cultural use. In: Food and Nutrition Technical Assistance II Project A. Washington, DC: FANTA; 2011.
    1. Ruel MT, Dewey KG, Martinez C, Flores R, Brown KH. Validation of single daytime samples of human milk to estimate the 24-h concentration of lipids in urban Guatemalan mothers. Am J Clin Nutr 1997;65:439–44.
    1. Brown KH, Black RE, Robertson AD, Akhtar NA, Ahmed G, Becker S. Clinical and field studies of human lactation: methodological considerations. Am J Clin Nutr 1982;35:745–56.
    1. Hampel D, Shahab-Ferdows S, Islam MM, Peerson JM, Allen LH. Vitamin concentrations in human milk vary with time within feed, circadian rhythm, and single-dose supplementation. J Nutr 2017;147:603–11.
    1. Hampel D, Shahab-Ferdows S, Domek JM, Siddiqua T, Raqib R, Allen LH. Competitive chemiluminescent enzyme immunoassay for vitamin B12 analysis in human milk. Food Chem 2014;153:60–5.
    1. Allen LH. How common is vitamin B-12 deficiency? Am J Clin Nutr. 2009;89:S693–6.
    1. WHO Indicators for Assessing Infant and Young Child Feeding Practices: Conclusions of A Consensus Meeting Held 6–8 November 2007, Washington, DC; 2008.
    1. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics 1986;42:121–30.
    1. Greibe E, Lildballe DL, Streym S, Vestergaard P, Rejnmark L, Mosekilde L, Nexo E. Cobalamin and haptocorrin in human milk and cobalamin-related variables in mother and child: a 9-mo longitudinal study. Am J Clin Nutr 2013;98:389–95.
    1. Deegan KL, Jones KM, Zuleta C, Ramirez-Zea M, Lildballe DL, Nexo E, Allen LH. Breast milk vitamin B-12 concentrations in Guatemalan women are correlated with maternal but not infant vitamin B-12 status at 12 months postpartum. J Nutr 2012;142:112–6.
    1. Finkelstein JL, Kurpad AV, Thomas T, Srinivasan K, Duggan C. Vitamin B12 status in pregnant women and their infants in South India. Eur J Clin Nutr 2017;71:1046–53.
    1. Sarari AS, Farraj MA, Hamoudi W, Essawi TA. Helicobacter pylori, a causative agent of vitamin B12 deficiency. J Infect Dev Ctries 2008;2:346–9.
    1. Chebaya P, Karakochuk CD, March KM, Chen NN, Stamm RA, Kroeun H, Sophonneary P, Borath M, Shahab-Ferdows S, Hampel D, et al.Correlations between maternal, breast milk, and infant vitamin B12 concentrations among mother-infant dyads in Vancouver, Canada and Prey Veng, Cambodia: an exploratory analysis. Nutrients 2017;9:pii:E270–80.
    1. Medoua GN, Sajo Nana EC, Ndzana AC, Makamto CS, Etame LS, Rikong HA, et al.Breastfeeding practices of Cameroonian mothers determined by dietary recall since birth and the dose-to-the-mother deuterium-oxide turnover technique. Matern Child Nutr 2012;8:330–9.
    1. Specker BL, Brazerol W, Ho ML, Norman EJ. Urinary methylmalonic acid excretion in infants fed formula or human milk. Am J Clin Nutr. 1990;51:209–11.
    1. Greiner T. Exclusive breastfeeding: measurement and indicators. Int Breastfeed J 2014;9:18.
    1. Lee SE, Talegawkar SA, Merialdi M, Caulfield LE. Dietary intakes of women during pregnancy in low- and middle-income countries. Public Health Nutr 2013;16:1340–53.
    1. Allen LH. The nutrition CRSP: what is marginal malnutrition, and does it affect human function? Nutr Rev 1993;51:255–67.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe