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Hemoglobin concentration is inversely associated with erythrocyte folate concentrations in Colombian school-age children, especially among children with low vitamin B12 status

European Journal of Clinical Nutrition volume 63, pages 842–849 (2009)Cite this article

Abstract

Background:

While the majority of cases of nutritional anemia in developing countries are caused by iron deficiency, other micronutrient deficiencies may also be involved. In Colombia, it was recently reported that 38% of school children were anemic; yet, the rate of iron deficiency was only 3.6%.

Objective:

To determine if micronutrients other than iron were responsible for low hemoglobin concentrations in Colombian school children.

Methods:

We examined hemoglobin concentrations in relation to plasma ferritin, vitamin A, vitamin B12, and erythrocyte folate levels in a representative sample of 2812 low- and middle-income children (5–12 years) from Bogotá, Colombia.

Results:

In multivariate analysis, hemoglobin concentration was positively associated with child's age, mother's age, household's socioeconomic stratum, and family income. Low ferritin was related to 3.6 g/l lower hemoglobin concentration (95% confidence interval=−6.0, −1.3). Unexpectedly, we found an inverse trend in hemoglobin concentration by quartiles of erythrocyte folate; the adjusted hemoglobin concentration difference between the highest and lowest folate quartiles was −6.0 g/l (95% confidence interval=−7.2, −4.9; P for trend <0.0001). This difference was greatest among children with vitamin B12 concentration <148 pmol/l (−11.5 g/l), followed by children with vitamin B12 concentration 148–221 pmol/l (−7.7 g/l), and smallest in children with vitamin B12 concentration >221 pmol/l (−5.7 g/l); P for interaction=0.04.

Conclusions:

Hemoglobin concentration is inversely related to erythrocyte folate concentrations in a setting where folate fortification was adopted more than a decade ago. The impact of improving vitamin B12 status on this inverse relationship should be examined.

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Acknowledgements

This research was supported by the Secretary of Education of Bogota, the David Rockefeller Center for Latin American Studies at Harvard University, the National University of Colombia, and the National Institute of Health of Colombia. Dr Arsenault is supported by the training grant T32DK07703 from the National Institutes of Health.

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Authors and Affiliations

  1. Department of Nutrition, Harvard School of Public Health, Boston, MA, USA

    J E Arsenault & E Villamor

  2. Department of Nutrition, National University of Colombia, Bogota, Colombia

    M Mora-Plazas

  3. Nutrition Group, National Institute of Health, Bogota, Colombia

    Y Forero

  4. San Rafael Clinic, Bogota, Colombia

    S Lopez-Arana

  5. Department of Community Health, Brown University, Providence, RI, USA

    A Baylin

  6. Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA

    E Villamor

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  1. J E Arsenault
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  4. S Lopez-Arana
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  5. A Baylin
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  6. E Villamor
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Correspondence to E Villamor.

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Contributors: JEA carried out the data analyses, interpreted the results, and wrote the initial draft of the manuscript. MMP participated in the study design and implementation in the field. YF contributed to the study implementation and carried out the laboratory analyses. SLA contributed to the study implementation and data management. AB contributed to the study design and interpretation of data. EV designed the study and contributed to data analyses and interpretation. All authors participated in the writing of the final draft of the manuscript.

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Arsenault, J., Mora-Plazas, M., Forero, Y. et al. Hemoglobin concentration is inversely associated with erythrocyte folate concentrations in Colombian school-age children, especially among children with low vitamin B12 status. Eur J Clin Nutr 63, 842–849 (2009). https://doi.org/10.1038/ejcn.2008.50

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