vitamin-b-12 and Malaria

Although a low serum folate concentration is a useful biomarker of pure folate deficiency, the presence of vitamin B12 deficiency or hemolysis or both in individuals with low folate status predictably raises serum folate levels. Therefore, in resource-limited settings where dietary folate deficiency can coexist with vitamin B12 deficiency or malaria or both, the serum folate concentration can range from normal to high, leading to serious underestimation of tissue folate status. This review traces the genesis of an inappropriate overreliance on the serum folate concentration to rule out folate deficiency in vulnerable populations of women and children. Of significance, without due consideration of a chronically inadequate dietary folate intake, authors of influential studies have likely wrongly judged these populations to have an adequate folate status. Through repetition, this error has led to a dangerous entry into the contemporary medical literature that folate deficiency is rare in women and children. As a consequence, many millions of under-resourced women and children with mild to moderate tissue folate deficiency may have been deprived of folate replacement. This review uses historical documents to challenge earlier conclusions and re-emphasizes the need for contextual integration of clinical information in resource-limited settings.

Topics: Biomarkers; Developing Countries; Diet; Environment; False Negative Reactions; Female; Folic Acid; Folic Acid Deficiency; Hematologic Tests; Humans; Malaria; Nutritional Status; Vitamin B 12; Vitamin B 12 Deficiency; Vulnerable Populations

In summary, it appears that giardiasis, coccidiosis, cryptosporidiosis, strongyloidiasis, capillariasis and perhaps P. falciparum malaria are the only parasitic diseases which cause malabsorption of many nutrients. D. latum and A. lumbricoides interfere with vitamin B12 and vitamin A absorption, respectively. In view of the increasing use of immunosuppressive therapy, it is likely that malabsorption caused by intestinal parasites may become even more evident in the future.

Topics: Ancylostomiasis; Apicomplexa; Ascariasis; Capillaria; Coccidiosis; Diphyllobothriasis; Giardiasis; Humans; Intestinal Diseases, Parasitic; Malabsorption Syndromes; Malaria; Nematode Infections; Plasmodium falciparum; Protozoan Infections; Schistosomiasis; Strongyloidiasis; Vitamin A; Vitamin B 12

Topics: Anemia; Anemia, Hypochromic; Anemia, Macrocytic; Anemia, Sickle Cell; Child; Child, Preschool; Feces; Female; Fever; Folic Acid; Hemoglobinopathies; Hookworm Infections; Humans; Infant; Leishmaniasis, Visceral; Malaria; Male; Pregnancy; Protozoan Infections; Schistosomiasis; Vitamin B 12

Animal source foods (ASF) can provide micronutrients in greater amounts and more bioavailable forms compared to plant source foods, but their intake is low in many poor populations. However, the impact of ASF on micronutrient status of undernourished populations has not been assessed. Supplemental meat (60-85 g/d), milk (200-250 mL/d) or energy (isocaloric with the meat and milk, 240-300 kcal/d) were randomly assigned to 555 undernourished school children aged 5-14 y in a rural malaria-endemic area of Kenya, at one school meal daily for one school year. Blood and stool samples were collected at baseline and after 1 y to assess stool parasites, malaria, hemoglobin, serum or plasma C-reactive protein, ferritin, iron, zinc, copper, vitamin B-12, folate and retinol, and erythrocyte riboflavin. At baseline, there was a high prevalence of micronutrient deficiencies (iron, zinc, vitamins A and B-12 and riboflavin), yet plasma ferritin was low in few children, and none had low serum copper. At the end of the year of supplementation, plasma vitamin B-12 concentrations were significantly increased in children fed the Meat or Milk meal; prevalence of severe plus moderate deficiency fell from 80.7% at baseline to 64.1% in the Meat group and from 71.6 to 45.1% in the Milk group, respectively. No significant improvement was observed in the status of other micronutrients compared to the Energy and Control groups, although malaria and other infections may have obscured effects. Supplementation with small amounts of meat or milk reduced the high prevalence of vitamin B-12 deficiency in these children.

Topics: Adolescent; Animals; Body Height; Body Weight; Child; Child, Preschool; Climate; Cognition; Deficiency Diseases; Energy Metabolism; Humans; Kenya; Malaria; Meat; Micronutrients; Milk; Parasitic Diseases; Prevalence; Vitamin B 12

The effect of folic acid supplement (15 mg folic acid per day) for 5 weeks was studied on a group of 5 children aged 8-12 years who were admitted to hospital. The result was compared to a control group of 5 children who were given a placebo. After supplementation, both serum and red cell folate levels in the experimental group significantly increased, i.e., 15 fold (82.0 ng/ml) and 4 fold (880 ng/ml), respectively. Serum UFBP decreased considerably while TFBP showed no significant alteration which resulted in the elevation of the % saturation to its maximum value. These findings indicated that the supplementary folic acid not only increased both serum and red cell folate levels and saturated nearly all serum UFBP but also elevated the % saturation markedly. There were no definite changes of serum vitamin B12, UBBC, TBBC and TC levels of the experimental group from those of the control group. There were slightly but not significantly increased blood haemoglobin and haematocrit levels in both groups of children. This indicated that folic acid supplement had no definite effect on vitamin B12 and haematological findings in this study.

Topics: Carrier Proteins; Child; Clinical Trials as Topic; Folate Receptors, GPI-Anchored; Folic Acid; Hematocrit; Hemoglobins; Humans; Malaria; Receptors, Cell Surface; Thailand; Transcobalamins; Vitamin B 12

Micronutrient deficiencies and stunting are prevalent. We assessed correlates of iron, cobalamin, folate, and vitamin A biomarkers in a cross-sectional study of stunted children aged 12-59 months in eastern Uganda. The biomarkers measured were serum ferritin (S-FE), soluble transferrin receptor (S-TfR), retinol binding protein (S-RBP), plasma cobalamin (P-Cob), methylmalonic acid (P-MMA), and folate (P-Fol). Using linear regression, we assessed socio-demography, stunting severity, malaria rapid test, and inflammation as correlates of micronutrient biomarkers. Of the 750 children, the mean (SD) age was 32.0 (11.7) months, and 45% were girls. Iron stores were depleted (inflammation-corrected S-FE < 12 µg/L) in 43%, and 62% had tissue iron deficiency (S-TfR > 8.3 mg/L). P-Cob was low (<148 pmol/L) and marginal (148-221 pmol/L) in 3% and 20%, and 16% had high P-MMA (>0.75 µmol/L). Inflammation-corrected S-RBP was low (<0.7 µmol/L) in 21% and P-Fol (<14 nmol/L) in 1%. Age 24-59 months was associated with higher S-FE and P-Fol and lower S-TfR. Breastfeeding beyond infancy was associated with lower iron status and cobalamin status, and malaria was associated with lower cobalamin status and tissue iron deficiency (higher S-TfR) despite iron sequestration in stores (higher S-FE). In conclusion, stunted children have iron, cobalamin, and vitamin A deficiencies. Interventions addressing stunting should target co-existing micronutrient deficiencies.

Topics: Anemia, Iron-Deficiency; Biomarkers; Child; Cross-Sectional Studies; Female; Folic Acid; Humans; Inflammation; Iron; Malaria; Male; Micronutrients; Nutritional Status; Uganda; Vitamin A; Vitamin B 12

Studies conducted in high income countries have shown that anaemia is a common medical condition among older people, but such data are scarce in Africa. The objectives of this study were to estimate the prevalence, types, risk factors and clinical correlates of anaemia in older people.. Participants were aged (≥ 50) years recruited from a general population cohort from January 2012 to January 2013. Blood samples were collected for assessing hemoglobin, serum ferritin, serum vitamin B12, serum folate, C-reactive protein, malaria infection and stool samples for assessment of hookworm infection. HIV status was assessed using an algorithm for HIV rapid testing. Questionnaires were used to collect data on sociodemographic characteristics and other risk factors for anaemia.. In total, 1449 people participated (response rate 72.3%). The overall prevalence of anaemia was 20.3 % (95% CI 18.2-22.3%), and this was higher for males (24.1%, 95% CI=20.7-27.7%) than females (17.5%, 95% CI=15.0-20.1%). In males, the prevalence of anaemia increased rapidly with age almost doubling between 50 and 65 years (p-trend<0.001). Unexplained anaemia was responsible for more than half of all cases (59.7%). Anaemia was independently associated with infections including malaria (OR 3.49, 95% CI 1.78-6.82), HIV (OR 2.17, 1.32-3.57) heavy hookworm infection (OR 3.45, 1.73-6.91), low fruit consumption (OR 1.55, 1.05-2.29) and being unmarried (OR 1.37 , 95% CI 1.01-1.89). However, the odds of anaemia were lower among older people with elevated blood pressure (OR 0.47, 95% CI 0.29-0.77).. Anaemia control programmes in Uganda should target older people and should include interventions to treat and control hookworms and educational programs on diets that enhance iron absorption. Clinicians should consider screening older people with HIV or malaria for anaemia. Further studies should be done on unexplained anaemia and serum ferritin levels that predict iron deficiency anaemia in older people.

Topics: Age Factors; Aged; Anemia; Blood Pressure; C-Reactive Protein; Cross-Sectional Studies; Female; Ferritins; Folic Acid; Hemoglobins; HIV Seropositivity; Hookworm Infections; Humans; Malaria; Male; Middle Aged; Odds Ratio; Prevalence; Risk Factors; Rural Population; Sex Factors; Uganda; Vitamin B 12

To investigate folacin concentrations in malaria during pregnancy, women attending a rural antenatal clinic in Kenya were studied. Low serum folacin values had poor specificity for low red blood cell (RBC) folacin concentrations. Multigravidae had lower mean serum folacin (p less than 0.03) and RBC folacin (p less than 0.001) values than primigravidae. Primigravidae had higher mean RBC folacin values than nulliparae (p less than 0.05). Although anemia was frequent, no evidence of neutrophil hypersegmentation was seen in blood smears of individuals with low RBC folacin or indeterminate cobalamin values. The unexpectedly high RBC folacin concentrations are probably related to P falciparum infection: during followup a significant decrease in both RBC and serum folacin activity occurred after chloroquine was administered. This decrease may be unrelated to a gestational effect (RBC folacin p less than 0.01; serum folacin p less than 0.025). The pathogenesis of high RBC folacin activity is discussed in relation to reticulocytosis as well as to a biochemical mechanism within the RBC.

Topics: Adolescent; Adult; Anemia; Erythrocyte Count; Erythrocytes; Female; Folic Acid; Follow-Up Studies; Humans; Kenya; Malaria; Parity; Plasmodium falciparum; Pregnancy; Pregnancy Complications, Hematologic; Pregnancy Complications, Infectious; Radioimmunoassay; Rural Health; Vitamin B 12

Topics: Adolescent; Adult; Brain Diseases; Female; Humans; Malaria; Male; Middle Aged; Plasmodium falciparum; Transcobalamins; Vitamin B 12

Folacin deficiency in malaria endemic areas is not reported other than in severely malnourished children. This is surprising in view of the high incidence in these areas of malaria in pregnancy, with its complications of prematurity and low birth weight, all of which can predispose to folacin deficiency. This paper reports results of folacin and cobalamin activities of blood samples collected from women at parturition and their newborns in a holoendemic area in West Kenya. Evidence is given that Plasmodium falciparum infection has little influence on cord plasma or red cell folacin activities. Mean values for folacin and cobalamin are not low when compared with reported values from neonates from temperate climates.

Topics: Erythrocytes; Female; Fetal Blood; Folic Acid; Humans; Infant, Newborn; Labor, Obstetric; Malaria; Pregnancy; Pregnancy Complications, Infectious; Time Factors; Vitamin B 12

Haematological studies in a group of Gambian children with severe anaemia due to Plasmodium falciparum malaria revealed marked dyserythropoietic changes in erythroblasts and evidence of increased ineffective erythropoiesis. In some cases, the bone marrow also showed a few giant metamyelocytes and ring sideroblasts. The results of deoxyuridine suppression tests indicated that these haematological disturbances were not a consequence of vitamin B12 or folate deficiency within marrow cells.

Topics: Anemia; Bone Marrow; Child, Preschool; Deoxyuridine; DNA; Erythropoiesis; Folic Acid; Humans; Infant; Malaria; Plasmodium falciparum; Vitamin B 12

Topics: Child; Humans; Malaria; Protein Binding; Transcobalamins; Vitamin B 12

Topics: Adolescent; Adult; Anemia; Anemia, Hypochromic; Blood Proteins; Deficiency Diseases; Erythrocytes; Female; Folic Acid; Glucosephosphate Dehydrogenase; Glucosephosphate Dehydrogenase Deficiency; Hematocrit; Hemoglobins; Humans; Intestinal Diseases, Parasitic; Iron; Iron Deficiencies; Lactation; Malaria; Male; Middle Aged; New Guinea; Pregnancy; Protein Binding; Sex Factors; Splenomegaly; Thalassemia; Vitamin B 12

Topics: Biopsy; Carotenoids; Digestive System; Humans; Intestinal Absorption; Intestinal Mucosa; Jejunum; Malaria; Methods; Plasmodium falciparum; Vitamin B 12; Xylose

Topics: Adolescent; Adult; Cobalt Isotopes; Hematocrit; Hemoglobins; Humans; Intestinal Absorption; Liver Function Tests; Malaria; Male; Middle Aged; Plasmodium falciparum; Thailand; Vitamin B 12

Topics: Amino Acids; Diet; Folic Acid; Folic Acid Deficiency; Food Analysis; Humans; Malaria; Pharmaceutical Preparations; Pyridoxine; Vitamin B 12