Prevalence of Vitamin B(12) and Folate Deficiencies in Indian Children and Adolescents

Deficiencies of vitamin B(12) (B(12)) and folate (FA) are of particular interest due to their pleiotropic role in 1-carbon metabolism. In addition to adverse birth outcomes, deficiencies of B(12) and FA, or an imbalance in FA/B(12) status, are linked to metabolic disorders. Indian diets that are predominantly plant food-based could be deficient in these vitamins, but there are no national estimates of the prevalence of B(12) and FA deficiency in Indian children and adolescents, nor their associations with age, sex and growth indicators. The recent Comprehensive National Nutrition Survey (CNNS-2016-18) provided estimates of the prevalence of B(12) and FA deficiency at the national and state levels among preschool (1–4 years: 9976 and 11,004 children, respectively), school-age children (5–9 years: 12,156 and 14,125) and adolescents (10–19 years: 11,748 and 13,621). Serum B(12) and erythrocyte FA were measured by the direct chemiluminescence method and their deficiency was defined using WHO cut-offs. The prevalence of B(12) and FA deficiency was high among adolescents (31.0%, CI: 28.7–33.5 and 35.6%, CI: 33.1–8.2) compared to school-age (17.3%, CI: 15.4–19.3 and 27.6%, CI: 25.5–29.9) and preschool children (13.8%, CI: 11.7–16.2 and 22.8%, CI: 20.5–25.2, respectively). The prevalence of both B(12) and FA deficiency was significantly higher by 8% and 5%, respectively, in adolescent boys compared to girls. There was no association between anthropometric undernutrition and B(12) and FA deficiency. There was wide regional variation in the prevalence of B(12) and FA deficiency, but no rural–urban differences were observed across all age groups. The national prevalence of B(12) deficiency among preschool or school-age children was <20% (the cut-off that indicates a public health problem). However, FA deficiency in these age groups and both FA and B(12) deficiencies in adolescents were >20%, warranting further investigation.