Diarrhea and novel dietary factors emerge as predictors of serum vitamin B12 in Panamanian children

Background. The role of gastrointestinal infection as a factor determining vitamin B-12 status in populations with low intake of animal-source foods is unclear. Objective. To determine dietary adequacy and serum concentrations of vitamin B-12 in an extremely impoverished indigenous population of Panamanian children aged 12 to 60 months, and to identify predictors of both dietary and serum vitamin B-12. 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 B-12 was assayed using electrochemiluminescence for 65 of these children. Children with adequate or inadequate dietary vitamin B-12 intake were compared, and predictors of dietary and serum vitamin B-12 were identified using step-wise regression analyses of one index child per household. Results. Dietary vitamin B-12 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 B-12 intake. In contrast, serum vitamin B-12 concentrations were normal in all but 3% of the children. Serum vitamin B-12 was positively associated with weekly servings of fruit, corn-based food, and name (a traditional starchy food), but not with animal-source foods. Finally, serum vitamin B-12 was not associated with Ascaris intensity but was lowered with increasing frequency of diarrhea. Conclusions. Although inadequate dietary intake of vitamin B-12 was common, most serum values were normal. Nevertheless, diarrheal disease emerged as a negative predictor of serum vitamin B-12 concentration.