Abstract:
OBJECTIVE:A metabolic profile consistent with impaired cobalamin status is prevalent in breastfed infants. We investigated whether this profile reflects immature organ systems or impaired cobalamin status. METHODS:In a single-center, randomized, placebo-controlled trial, we studied 107 six-week-old infants. The infants were randomly assigned to receive either an intramuscular injection of 400 mug of cobalamin or no intervention. Concentrations of cobalamin and folate in serum and total homocysteine, methylmalonic acid, and cystathionine in plasma were determined at enrollment and at the age of 4 months. RESULTS:There were no significant differences between the intervention group (n = 54) and the control group (n = 53) in the concentrations of any vitamin marker at baseline (6 weeks). At 4 months, the supplement-treated infants had a 75% higher median serum cobalamin level and remarkable reductions in median plasma total homocysteine (from 7.46 to 4.57 micromol/L) and methylmalonic acid (from 0.58 to 0.20 micromol/L) levels, whereas levels of both metabolites were essentially unchanged during the follow-up period in the control group. CONCLUSIONS:Cobalamin supplementation changed all markers of impaired cobalamin status (low cobalamin, high total homocysteine, and high methylmalonic acid levels) toward a profile observed in cobalamin-replete older children and adults. Therefore, the high total homocysteine and methylmalonic acid levels reported for a large fraction of infants reflect not immature metabolism but rather insufficient cobalamin levels to fully sustain cobalamin-dependent reactions fully.
journal_name
Pediatricsjournal_title
Pediatricsauthors
Bjørke-Monsen AL,Torsvik I,Saetran H,Markestad T,Ueland PMdoi
10.1542/peds.2007-2716subject
Has Abstractpub_date
2008-07-01 00:00:00pages
83-91issue
1eissn
0031-4005issn
1098-4275pii
122/1/83journal_volume
122pub_type
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