{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T18:46:23Z","timestamp":1792003583634,"version":"4.4.0"},"reference-count":37,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2017,1,17]],"date-time":"2017-01-17T00:00:00Z","timestamp":1484611200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Many children in low- and middle-income countries may have inadequate intake of vitamin B12 and folate; data confirming these inadequacies are limited. We used biochemical, demographic, behavioral and anthropometric data to describe the folate and vitamin B12 concentrations among six- to 23-month-old Nepalese children. Vitamin B12 (serum B12 &lt; 150 pmol\/L) and folate deficiencies (red blood cell (RBC) folate &lt; 226.5 nmol\/L) were assessed. We used logistic regression to identify predictors of vitamin B12 deficiency. The vitamin B12 geometric mean was 186 pmol\/L; 30.2% of children were deficient. The mean RBC folate concentration was 13,612 nmol\/L; there was no deficiency. Factors associated with vitamin B12 deficiency included: (a) age six to 11 months (adjusted odds ratio (aOR) 1.51; 95% confidence interval (CI): 1.18, 1.92) or 12\u201317 months (aOR 1.38; 95% CI: 1.10, 1.72) compared to 18\u201323 months; (b) being stunted (aOR 1.24; 95% CI: 1.03, 1.50) compared to not being stunted; (c) and not eating animal-source foods (aOR 1.85; 95% CI: 1.42, 2.41) compared to eating animal-source foods the previous day. There was a high prevalence of vitamin B12 deficiency, but no folate deficiency. Improving early feeding practices, including the consumption of rich sources of vitamin B12, such as animal-source foods and fortified foods, may help decrease deficiency.<\/jats:p>","DOI":"10.3390\/nu9010072","type":"journal-article","created":{"date-parts":[[2017,1,18]],"date-time":"2017-01-18T10:00:47Z","timestamp":1484733647000},"page":"72","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["High Prevalence of Vitamin B12 Deficiency and No Folate Deficiency in Young Children in Nepal"],"prefix":"10.3390","volume":"9","author":[{"given":"Bernadette","family":"Ng\u2019eno","sequence":"first","affiliation":[{"name":"Epidemic Intelligence Service, Division of Scientific Education and Professional Development, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA"},{"name":"Division of Nutrition, Physical Activity &amp; Obesity, Centers for Disease Control and Prevention, 4770, Buford Hwy, Chamblee, GA 30341, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cria","family":"Perrine","sequence":"additional","affiliation":[{"name":"Division of Nutrition, Physical Activity &amp; Obesity, Centers for Disease Control and Prevention, 4770, Buford Hwy, Chamblee, GA 30341, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ralph","family":"Whitehead","sequence":"additional","affiliation":[{"name":"Division of Nutrition, Physical Activity &amp; Obesity, Centers for Disease Control and Prevention, 4770, Buford Hwy, Chamblee, GA 30341, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giri","family":"Subedi","sequence":"additional","affiliation":[{"name":"Child Health Division, Ministry of Health and Population, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saba","family":"Mebrahtu","sequence":"additional","affiliation":[{"name":"Nutrition Section, UNICEF, UN House, Pulchowk, Lalitpur, P.O. Box 1187, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pradiumna","family":"Dahal","sequence":"additional","affiliation":[{"name":"Nutrition Section, UNICEF, UN House, Pulchowk, Lalitpur, P.O. Box 1187, Kathmandu 44600, Nepal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Jefferds","sequence":"additional","affiliation":[{"name":"Division of Nutrition, Physical Activity &amp; Obesity, Centers for Disease Control and Prevention, 4770, Buford Hwy, Chamblee, GA 30341, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2017,1,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1067\/mpd.2001.112160","article-title":"Vitamin B12 deficiency in children and adolescents","volume":"138","author":"Rasmussen","year":"2001","journal-title":"J. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"699","DOI":"10.1136\/adc.54.9.699","article-title":"Folate nutrition and growth in infancy","volume":"54","author":"Matoth","year":"1979","journal-title":"Arch. Dis. Child."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1093\/ajcn\/86.1.139","article-title":"Folate, but not vitamin B-12 status, predicts respiratory morbidity in north Indian children","volume":"86","author":"Strand","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1016\/j.ejpn.2009.12.003","article-title":"Clinical presentation and metabolic consequences in 40 breastfed infants with nutritional vitamin B12 deficiency\u2014What have we learned?","volume":"14","author":"Honzik","year":"2010","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"S126","DOI":"10.1177\/15648265080292S117","article-title":"Effects of vitamin B12 and folate deficiency on brain development in children","volume":"29","author":"Black","year":"2008","journal-title":"Food Nutr. Bull."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1177\/15648265080292S105","article-title":"Causes of vitamin B12 and folate deficiency","volume":"29","author":"Allen","year":"2008","journal-title":"Food Nutr. Bull."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Allen, L.H. (1994). Nutrient Regulation during Pregnancy, Lactation, and Infant Growth, Springer.","DOI":"10.1007\/978-1-4899-2575-6"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"3000S","DOI":"10.1093\/jn\/133.9.3000S","article-title":"B vitamins: Proposed fortification levels for complementary foods for young children","volume":"133","author":"Allen","year":"2003","journal-title":"J. Nutr."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"856","DOI":"10.1038\/sj.ejcn.1601236","article-title":"Original Communications-Homocysteine and methylmalonic acid levels in pregnant Nepali women. Should cobalamin supplementation be considered?","volume":"55","author":"Bondevik","year":"2001","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1093\/jn\/135.5.1106","article-title":"Micronutrient deficiencies in early pregnancy are common, concurrent, and vary by season among rural Nepali pregnant women","volume":"135","author":"Jiang","year":"2005","journal-title":"J. Nutr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S29","DOI":"10.1111\/j.1753-4887.2004.tb00069.x","article-title":"Folate and vitamin B12 status in the Americas","volume":"62","author":"Allen","year":"2004","journal-title":"Nutr. Rev."},{"key":"ref_12","first-page":"S35","article-title":"Discussion: Causes of vitamin B","volume":"29","author":"Carmel","year":"2008","journal-title":"Folate Vitam. B"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1289","DOI":"10.1001\/archinte.159.12.1289","article-title":"Laboratory diagnosis of vitamin B12 and folate deficiency: A guide for the primary care physician","volume":"159","author":"Snow","year":"1999","journal-title":"Arch. Intern. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"92","DOI":"10.3945\/ajcn.112.057489","article-title":"Impact of continuing folic acid after the first trimester of pregnancy: Findings of a randomized trial of Folic Acid Supplementation in the Second and Third Trimesters","volume":"98","author":"McNulty","year":"2013","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_15","unstructured":"Ministry of Health (2012). Nepal Demographic Health Survey 2011."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Ulak, M., Chandyo, R.K., Thorne-Lyman, A.L., Henjum, S., Ueland, P.M., Midttun, \u00d8., Shrestha, P.S., Fawzi, W.W., Graybill, L., and Strand, T.A. (2016). Vitamin Status among Breastfed Infants in Bhaktapur, Nepal. Nutrients, 8.","DOI":"10.3390\/nu8030149"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Ulak, M., Chandyo, R.K., Adhikari, R.K., Sharma, P.R., Sommerfelt, H., Refsum, H., and Strand, T.A. (2014). Cobalamin and folate status in 6 to 35 months old children presenting with acute diarrhea in Bhaktapur, Nepal. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0090079"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"3201","DOI":"10.1017\/S1368980015000671","article-title":"Low dietary diversity and micronutrient adequacy among lactating women in a peri-urban area of Nepal","volume":"18","author":"Henjum","year":"2015","journal-title":"Public Health Nutr."},{"key":"ref_19","unstructured":"World Health Organization (2010). Indicators for Assessing Infant and Young Child Feeding Practices: Part 2: Measurement, World Health Organization."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"90","DOI":"10.1016\/j.cca.2008.01.009","article-title":"The CDC VITAL-EQA program, external quality assurance for serum retinol, 2003\u20132006","volume":"390","author":"Haynes","year":"2008","journal-title":"Clin. Chim. Acta"},{"key":"ref_21","unstructured":"World Health Organization (1995). Physical Status: The Use and Interpretation of Anthropometry, World Health Organization. Report of a WHO Expert Committee."},{"key":"ref_22","unstructured":"World Health Organization (2011). Vitamin and Mineral Nutrition Information System, World Health Organization."},{"key":"ref_23","unstructured":"World Health Organization (2015). Serum and Red Blood Cell Folate Concentrations for Assessing Folate Status in Populations, World Health Organization."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S238","DOI":"10.1177\/15648265080292S129","article-title":"Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies","volume":"29","year":"2008","journal-title":"Food Nutr. Bull."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"69","DOI":"10.2307\/3181060","article-title":"Impact and determinants of sex preference in Nepal","volume":"29","author":"Leone","year":"2003","journal-title":"Int. Fam. Plan. Perspect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1093\/ajcn\/86.5.1302","article-title":"Cobalamin and folate status in infants and young children in a low-to-middle income community in India","volume":"86","author":"Taneja","year":"2007","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1590\/S0036-36342012000200007","article-title":"Prevalence of folate and vitamin B12 deficiency in Mexican children aged 1 to 6 years in a population-based survey","volume":"54","author":"Villalpando","year":"2012","journal-title":"Salud Publ. Mex."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1093\/jn\/137.3.676","article-title":"Low plasma vitamin B-12 in Kenyan school children is highly prevalent and improved by supplemental animal source foods","volume":"137","author":"McLean","year":"2007","journal-title":"J. Nutr."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1746-4358-7-1","article-title":"Infant feeding practices in Bhaktapur, Nepal: A cross-sectional, health facility based survey","volume":"7","author":"Ulak","year":"2012","journal-title":"Int. Breastfeed. J."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1863","DOI":"10.1093\/jn\/137.8.1863","article-title":"Longitudinal study of the effect of pregnancy on maternal and fetal cobalamin status in healthy women and their offspring","volume":"137","author":"Murphy","year":"2007","journal-title":"J. Nutr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"792","DOI":"10.1016\/0002-9378(81)90706-7","article-title":"Role of placenta in maternal-fetal vitamin transfer in humans","volume":"141","author":"Baker","year":"1981","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.1093\/ajcn\/52.6.1073","article-title":"Vitamin B-12: Low milk concentrations are related to low serum concentrations in vegetarian women and to methylmalonic aciduria in their infants","volume":"52","author":"Specker","year":"1990","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"362","DOI":"10.3945\/an.111.001172","article-title":"B vitamins in breast milk: Relative importance of maternal status and intake, and effects on infant status and function","volume":"3","author":"Allen","year":"2012","journal-title":"Adv. Nutr. Int. Rev. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1111\/j.1651-2227.2012.02613.x","article-title":"Undernutrition in Nepalese children: A biochemical and haematological study","volume":"101","author":"Ghosh","year":"2012","journal-title":"Acta Paediatr."},{"key":"ref_35","first-page":"543","article-title":"Stunting and micronutrient deficiencies in malnourished children","volume":"60","author":"Ejaz","year":"2010","journal-title":"J. Pak. Med. Assoc."},{"key":"ref_36","unstructured":"World Health Organization, UNICEF (2003). Global Strategy for Infant and Young Child Feeding, World Health Organization."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1093\/ajcn\/88.1.105","article-title":"Folate and cobalamin status in relation to breastfeeding and weaning in healthy infants","volume":"88","author":"Hay","year":"2008","journal-title":"Am. J. Clin. Nutr."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/9\/1\/72\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T18:26:22Z","timestamp":1760207182000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/9\/1\/72"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,1,17]]},"references-count":37,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2017,1]]}},"alternative-id":["nu9010072"],"URL":"https:\/\/doi.org\/10.3390\/nu9010072","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,1,17]]}}}