[Severe vitamin B12 deficiency in infants breastfed by vegans]
Rigshospitalet, Børneafdelingen, Klinisk Genetisk Afdeling, og Hvidovre Hospital, Børneafdelingen, Denmark.Ugeskrift for laeger 10/2009; 171(43):3099-101.
Weight loss and reduction of motor skills resulted in paediatric evaluation of a 10-month-old girl and a 12-month-old boy. Both children suffered form anaemia and delayed development due to vitamin B12 deficiency caused by strict maternal vegan diet during pregnancy and nursing. Therapy with cyanocobalamin was instituted with remission of symptoms. Since infants risk irreversible neurologic damage following severe vitamin B12 deficiency, early diagnosis and treatment are mandatory. Vegan and vegetarian women should take vitamin B12 supplementation during the pregnancy and nursing period.
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ABSTRACT: Maternal nutrition is an important determinant of the duration of pregnancy and fetal growth, and thereby influences pregnancy outcome. Folic acid and vitamin B(12) are involved in one-carbon metabolism and are reported to underlie intrauterine programming of adult diseases. In the present study, the levels of folate, vitamin B(12) and homocysteine were measured in mothers delivering preterm (PT; gestation <37 weeks; n = 67), those delivering preterm due to preeclampsia (PT-PE; n = 49) and women delivering at term (control group; n = 76). Increased vitamin B(12) and homocysteine levels (p < 0.05 for both) were seen in the PT-PE and PT groups as compared to the controls. In addition, reduced folate levels (p < 0.05) were observed in the PT group. A negative association of maternal plasma homocysteine with birth weight was seen in the idiopathic preterm group. Altered maternal micronutrients and resultant increased homocysteine concentrations exist in women delivering preterm. These alterations may also be partly associated with other factors such as undiagnosed inflammatory conditions or inadequate placentation in some women. Since these micronutrients play an important role in epigenetic regulation of vital genes involved in the fetal programming of adult diseases, further studies need to be undertaken to understand their role in preterm deliveries.
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ABSTRACT: Maternal vitamin B-12 deficiency leads to an adverse pregnancy outcome and increases the risk for developing diabetes and metabolic syndrome in mothers in later life. Our earlier studies have demonstrated that vitamin B-12 and n-3 polyunsaturated fatty acids (PUFA) are interlinked in the one carbon cycle. The present study for the first time examines the effect of maternal n-3 PUFA supplementation to vitamin B-12 deficient or supplemented diets on pregnancy outcome, fatty-acid status and metabolic variables in Wistar rats. Pregnant dams were assigned to one of the following groups: control, vitaminB(12) deficient, vitaminB(12) supplemented, vitaminB(12) deficient+n-3 PUFA or vitaminB(12) supplemented+ n-3 PUFA. The amount of vitamin B-12 in the supplemented group was 0.50 mu g kg(-1) diet and n-3 PUFA was alpha linolenic acid (ALA) 1.68, eicosapentaenoic acid 5.64, docosahexaenoic acid (DHA) 3.15 (g per 100 g fatty acids per kg diet). Our findings indicate that maternal vitamin B-12 supplementation did not affect the weight gain of dams during pregnancy but reduced litter size and weight and was ameliorated by n-3 PUFA supplementation. Vitamin B-12 deficiency or supplementation resulted in a low percentage distribution of plasma arachidonic acid and DHA. n-3 PUFA supplementation to these diets improved the fatty-acid status. Vitamin B-12 deficiency resulted in higher homocysteine and insulin levels, which were normalised by supplementation with either vitamin B-12 or n-3 PUFA. Our study suggests that maternal vitamin B-12 status is critical in determining pregnancy outcome and metabolic variables in dams and that supplementation with n-3 PUFA is beneficial.
Article: Ernährung gesunder Säuglinge[Show abstract] [Hide abstract]
ABSTRACT: The Nutrition Committee of the German Pediatric Society has updated its recommendations for the nutrition of healthy infants. Five main topics (breastfeeding, breast milk substitutes, complementary feeding, family diet and general aspects) are addressed in the form of 35 key statements along with detailed comments on their practical application. Exclusive breastfeeding is recommended as the most suitable for almost all infants during the first 4–6 months, followed by partial breastfeeding along with complementary feeding; breastfeeding needs specific support particularly postnatal and routine supplementary feeding should be avoided. Non-breast-fed infants should receive infant formula, which should also accompany complementary feeding. In cases of increased risk for atopy, a formula based on hydrolyzed protein (HA) should be given until the start of complementary feeding. Follow-on formula may be given together with complementary feeding. Bottle feeds should be freshly prepared and given without delay. Complementary feeding should be introduced between the beginning of the fifth and the seventh month and at this time small amounts of gluten should also be introduced. Variation of complementary feeds is recommended. A vegetable-potato-meat or fish puree (highly bioavailable iron, omega-3 fatty acids) is well-suited to start complementary feeding, followed by (whole) cow’s milk cereal meal and a cereal–fruit meal, either homemade or as a commercial product. At the age of approximately 10 months infants can participate in a healthy family diet. A lactovegetarian type diet is possible; however a vegan diet if not supplemented cannot be acceptable for infants. Supplementation of 2 mg vitamin K orally 3 times (on day 1, between days 3 and 10, and between weeks 4–6 after birth) and of vitamin D (400–500 IU/day) starting from the 2nd week of life combined with fluoride (0.25 mg/day) in tablet form is recommended for all healthy infants.
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