Clinical and Brain Imaging Findings in a Child with Vitamin B12 Deficiency

Dietary supplement use among lactating mothers following different dietary patterns - an online survey

BACKGROUND

Breastfeeding is important for the healthy growth and development of newborns, and the nutrient composition of human milk can be affected by maternal nutrition and supplementation. In Germany, iodine supplementation is recommended for all lactating mothers, and docosahexaenoic acid (DHA) supplementation is recommended for mothers with inadequate or no fish intake. Vitamin B12 supplementation is required for strict vegans during lactation, and other nutrient supplementation may be necessary depending on the individual's nutritional status. To address the lack of data on dietary supplements used by lactating mothers following a vegetarian or vegan diet, an online survey was conducted in Germany, with a focus on iodine, DHA, and vitamin B12.

METHODS

Study participants were asked to report whether they followed specific dietary patterns (omnivorous [OM], vegetarian [VT], vegan [VN]) as well as their use of dietary supplements. Relationships between diets and supplement use were analyzed using chi-square tests.

RESULTS

2054 lactating women were included (1240 OM, 410 VT, and 404 VN) in this analysis. Within OM, VT and VN, at least one dietary supplement was taken by 67.3%, 84.9% and 98.0% respectively (p < 0.001). Overall, 53.2% OM, 66.8% VT, 88.4% VN reported taking at least one supplement containing iodine (p < 0.001). 54.6% OM, 61.7% VT and 58.2% VN reported supplements containing vitamin B12, while 34.1% OM, 40.2% VT and 38.6% VN mentioned supplements containing DHA (p < 0.05).

CONCLUSION

More than half of the participants reported the use of supplements during lactation with the highest proportion in vegans. However, over one third of the mothers did not report supplementing with iodine, regardless of their dietary pattern and most participants also did not report DHA supplements. It is worrisome that a high number of vegans did not report vitamin B12 supplementation, but this could be partly due to issues with reporting. It is crucial to provide further education to breastfeeding mothers about the importance of taking micronutrient supplements, especially for those following a vegetarian or vegan diet. This will help ensure that mothers and their breastfed infants receive optimal nutrition for a healthy development.

Biochemical, Nutritional, and Clinical Parameters of Vitamin B12 Deficiency in Infants: A Systematic Review and Analysis of 292 Cases Published between 1962 and 2022

Pooled data from published reports on infants with clinically diagnosed vitamin B12 (B12) deficiency were analyzed with the purpose of describing the presentation, diagnostic approaches, and risk factors for the condition to inform prevention strategies. An electronic (PubMed database) and manual literature search following the PRISMA approach was conducted (preregistration with the Open Science Framework, accessed on 15 February 2023). Data were described and analyzed using correlation analyses, Chi-square tests, ANOVAs, and regression analyses, and 102 publications (292 cases) were analyzed. The mean age at first symptoms (anemia, various neurological symptoms) was four months; the mean time to diagnosis was 2.6 months. Maternal B12 at diagnosis, exclusive breastfeeding, and a maternal diet low in B12 predicted infant B12, methylmalonic acid, and total homocysteine. Infant B12 deficiency is still not easily diagnosed. Methylmalonic acid and total homocysteine are useful diagnostic parameters in addition to B12 levels. Since maternal B12 status predicts infant B12 status, it would probably be advantageous to target women in early pregnancy or even preconceptionally to prevent infant B12 deficiency, rather than to rely on newborn screening that often does not reliably identify high-risk children.

Neuroimaging Findings in Vitamin B12-Deficient Infants With Neurologic Features

Background:Vitamin B₁₂ deficiency causes serious neurologic problems among infants. However, its neuroradiologic correlate is still largely obscure. Methodology: This prospective study was conducted on patients aged 6 months to 2 years. All children with proven vitamin B₁₂ deficiency were planned to undergo magnetic resonance imaging (MRI) and magnetic resonance spectroscopy of the brain. Results: A total of 35 patients (63% female) were enrolled. Twenty-six (74%) patients had significant findings on brain MRI scan, commonest of which were thinning of corpus callosum and prominence of extra-axial spaces in 28.6% children, cerebral atrophy in 17%, and diffuse symmetrical hyperintensity of white matter in 5.7% patients. Using logistic regression, it was found that odds of abnormal neuroimaging findings were higher in children below 12 months, in females, and in patients with developmental regression, but none of them were statistically significant. Conclusion: Most of the infants with vitamin B₁₂ deficiency have abnormal neuroimaging findings.