B12 deficiency is an enormous, yet overlooked problem, and the food relief we currently supply is not helping. According to the researchers, the problem calls for new solutions.
In Denmark, cases of poor psychomotor development are regularly seen in young children raised on vegan diets, though such outcomes are preventable with daily B12 supplements. But for children in low-income countries, the chances of ever meeting their vitamin B12 requirements are far worse.
This is reflected in widespread B12 deficiency among young children in Burkina Faso, according to a study from the University of Copenhagen conducted in collaboration with Médecins Sans Frontières (Doctor’s Without Borders).
The results have been published in the renowned journal Plos Medicine.
“Among the many children who participated in our study, we found a strong correlation between vitamin B12 deficiency and poor motor development and anemia,” says Henrik Friis, first author of the study and a professor at the University of Copenhagen’s Department of Nutrition, Exercise and Sports.
For many years, there has been a focus on vitamin A, zinc and iron deficiencies when it comes to malnutrition across the globe, whereas there is a paucity of research on B12 deficiency.
“B12 deficiency is one of the most overlooked problems out there when it comes to malnutrition. And unfortunately, we can see that the food relief we provide today is not up to the task,” says Henrik Friis, who has worked with nutrition and health in low-income countries for many years.
Over 1,000 children with acute malnutrition aged 6-23 months participated in the study. The children’s B12 levels were measured both before and after three months of daily food relief rations containing the recommended B12 content. When the study began, two-thirds of the children had either low or marginal levels of B12.
Short term food relief does not fill up B12 stores
“During the period when children were provided with food relief, their B12 levels increased, before decreasing considerably once we stopped the program. Despite provisioning them with food relief for three months, their stores remained far from topped up. This, when a typical food relief program only runs for four weeks,” says Henrik Friis.
Even after three months of food relief, one third of the children continued to have low or marginal levels of B12 stored. The unfortunate explanation is that there is a cap on how much B12 can be absorbed.
“A child’s gut can only absorb 1 microgram of B12 per meal. So, if a child is lacking 500 micrograms, it will take much longer than the few weeks that they have access to emergency food relief,” explains Vibeke Brix Christensen, a pediatrician and medical advisor to Médecins Sans Frontières and co-author of the study.
“Furthermore, longer-term relief programs aren’t realistic, as humanitarian organizations are trying to reduce the duration of treatment regimens with the aim of being able to serve a larger number of children for the same amount of money”, continues Vibeke Brix Christensen.
She points out that it might make a difference to divide the necessary amount of vitamin B12 across several meals, which would probably allow children to absorb the same amount of B12 each time. But the problem is that if widespread B12 deficiency appears among children in low-income countries, it is difficult to do anything about it.
New solutions needed on the table
Preventing B12 deficiency would be the best course of action. Unfortunately, lasting solutions have yet to become readily available according to Professor Friis.
Because our bodies cannot produce B12 on their own, we need to have it supplied to us through animal-based products or synthetic supplements. However, in many low-income countries, access to animal-based foods is incredibly difficult for the general population. One might wonder, are tablets or fortified foodstuffs the way to prevention?
“Possibly, but the problem in low-income countries is poorly resourced and weak health care systems. Handing out tablets to millions and millions of people is not cost-effective. And to enrich foods with B12, it must be added to foodstuffs that are accessible to the poor. This requires industrial expansion, as many people currently eat only what they can produce themselves. Furthermore, it requires legislation that it is not based on voluntary participation,” says Henrik Friis, who has greater faith in other types of solutions:
“Individual households could be incentivized to keep chickens and perhaps goats, which a mother could manage and use to provide access to animal-based foodstuffs. Finally, work needs to be done to develop fermented products with B12 producing bacteria – something that doesn’t yet exist, but towards which researchers and companies are already working,” concludes Henrik Friis.
The researchers are in dialogue with UNICEF’s Supply Division, based in Copenhagen, about how products to treat moderate to acute malnutrition can be improved.
- B12 deficiency can be transmitted from mother to child. If a mother is B12 deficient, her child will be born B12 deficient as well, before receiving breast milk with too little B12 in it. A child’s B12 deficiency can affect the formation and regeneration of their intestinal cells. Consequently, the child’s capacity to absorb B12 and other vital nutrients will be reduced. In this way, B12 deficiency contributes to the development of malnutrition.
ABOUT ACUTE MALNUTRITION
- Since 2010, the Department of Nutrition, Exercise and Sports (NEXS) at the University of Copenhagen has worked with the WHO and UNICEF, among others, with a focus on improving the emergency food relief used to combat childhood malnutrition.
- According to UNICEF, approximately 200 million children under the age of five suffer from malnutrition worldwide. Malnutrition contributes to the death of three million children every year.
- Acute malnutrition in children is characterized by children who are too thin in proportion to their height. Globally, it is estimated that approximately 50 million children are acutely malnourished, with two thirds of these suffering from moderate malnutrition and the remaining third suffering from severely acute malnutrition.
- Today, only about 20% of severely malnourished children receive emergency food relief.
Nutrients and Cognitive Development
Malnutrition is characterized by an imbalance between a person’s nutrient requirements and their nutrient consumption, and includes conditions of overnutrition and undernutrition [1,2,3]. Undernutrition is caused by an inadequate intake of energy, protein, or vitamins and minerals , and is a present-day global problem hindering the development of young children [4,5,6,7,8,9].
For young children, undernutrition can cause emaciation, stunting, and wasting, or various micronutrient deficiencies [1,2,3,4]. Worldwide, 149 million children are stunted and 45 million are wasted . Inadequate protein and energy intake in childhood is directly associated with reduced growth, and is indicative of several psychosocial problems later in life [3,10].
Undernourished children also exhibit impaired development and decreased functional capacity . Pediatric undernutrition is characterized by a lack of adequate weight gain, low weight per height, or low weight per length, and is a direct contributor to impaired cognitive skills [11,12,13].
The human brain requires all essential nutrients, including protein, fats, carbohydrates, vitamins, minerals, and water, to form and maintain its structure. Therefore, adequate nutrition is essential for brain development and function [14,15,16].
However, micronutrients, such as iron, zinc, choline, iodine, folate, B12, and long-chain polyunsaturated fatty acids (LC-PUFAs) have been identified to be particularly relevant to cognitive development .
Iron is essential for the development of neurological pathways in the brain that influence brain function [15,17,18,19]. During the first two years of life, children experience rapid growth, which increases their iron requirement and places them at a higher risk for iron deficiency anemia . Iron deficiency or iron deficiency anemia can negatively impact overall intelligence and cognitive development, especially if it occurs in early childhood [15,19,21].
Zinc is an essential trace mineral present in the brain that contributes to cerebral structure and function . Zinc deficiency during infancy is associated with motor development delays  and detrimental effects on attention and short-term memory . Long-term zinc deficiency is associated with stunting [24,25].
Choline is essential for the structural integrity of cell membranes and myelination [9,26,27]. Animal studies have shown choline deficiency to adversely impact memory [15,28,29]. Yet, the effects of choline on cognition in humans are still not fully understood. Iodine is an essential mineral for thyroid hormone synthesis and is required for brain development .
Iodine deficiency can have detrimental effects on cognitive function, and is the primary cause of intellectual disability around the world [15,30]. Folate is a water-soluble vitamin needed for DNA and RNA synthesis and the formation of the nervous system [15,31,32]. Maternal folate deficiency during the early stages of pregnancy is associated with an increased incidence of congenital malformations, including spina bifida and anencephaly [15,33].
Vitamin B12 is a cofactor in numerous catalytic reactions required for neurotransmitter synthesis and functioning [31,34]. Studies have linked B12 deficiency to cerebral atrophy and neurological disorders [34,35].
Vitamin A plays a critical-essential role in visual function [14,15]. LC-PUFAs, specifically docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), are required for brain growth and development . Inadequate intake of LC-PFAs is associated with impaired neurodevelopment, visual recognition, and memory [36,37,38].
Nutritional Interventions during the Preschool Years and Cognitive Outcomes
The first 1000 days of life are a crucial brain development period in which adequate nutrition is vital for optimal growth and cognitive development [39,40,41]. This has been identified as a sensitive time in which children are most vulnerable to behavioral and cognitive deficits .
A systematic review focusing on the first 1000 days of life identified the important role macronutrients, such as protein and LC-PUFAs, play in optimizing brain development . Specifically, protein-energy malnutrition in early life can impede adequate brain growth, resulting in smaller brains .
Another review showed maintenance of adequate iron and zinc status contributes to adequate growth in early life, as significant positive effects were seen on child weight-for-age z-score (WAZ) and weight-for-height z-score . Furthermore, maternal or child supplementation with choline has also been shown to support normal brain development .
Since the identification of the first 1000 days of life as a crucial cognitive development period, policy makers have placed strong emphasis on implementing nutritional policies that promote the healthy brain development of infants and toddlers . However, public policy often does not extend to preschool-age children, even though the second 1000 days of life also represent a critical time in children’s cognitive and behavioral growth .
Children experience the most dynamic developmental changes during the preschool years, and acquire important skills that contribute to school readiness . In particular, working memory and attention control undergo rapid progress, having an extensive impact on children’s academic achievement in later years [44,45]. Cognitive development reached in preschool years often predicts later achievements in life [45,46,47].
However, few articles have explored the effects of nutritional interventions on the cognitive outcomes of preschool-aged children. Children who do not receive adequate nutrition and psychosocial stimulation are likely to underperform in school and to have poor levels of cognition and education, which are linked to low-income earnings later in life [46,48,49].
This systematic review aimed to synthesize and evaluate the impact of nutritional interventions on the cognitive outcomes of preschool-aged children. The effects of food-based, single, and multiple micronutrient supplementation interventions were considered, in order to explore the correlation between nutrition interventions and cognitive performance.
reference link : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8839299/
Original Research: Open access.
“Serum cobalamin in children with moderate acute malnutrition in Burkina Faso: Secondary analysis of a randomized trial” by Henrik Friis et al. PLOS Medicine