Prevalence of vitamin B12 deficiency in healthy Indian school-going adolescents from rural and urban localities and its relationship with various anthropometric indices: a cross-sectional study.

BACKGROUND: Micronutrient deficiency is a global health burden, especially among developing countries. The present cross-sectional study aimed to determine the prevalence of vitamin B12 deficiency in healthy Indian school-going adolescents, based on area of residence, sex and body mass index (BMI). Furthermore, the relationship of serum B12 concentration with dietary vitamin B12 intake and anthropometric indices was assessed among adolescents from rural and urban India. METHODS: A total of 2403 school-going adolescents (11-17 years) from National Capital Region and rural areas of Haryana, India were selected. Serum B12 concentrations were estimated using an electrochemiluminescence immunoassay. Dietary assessments were conducted on 65% of total participants (n = 1556) by two 24-h diet recalls. RESULTS: The prevalence of vitamin B12 deficiency in the total study population was 32.4% (rural: 43.9% versus urban: 30.1%, P < 0.001; male: 34.4% versus female: 31.0%, P < 0.05; normal weight: 28.1%, versus overweight: 39.8%, versus obese: 51.2%, P < 0.001). More than half (51.2%) of obese adolescents were vitamin B12 deficient. On multiple linear regression analysis, serum B12 in rural adolescents was associated with age (ß = -0.12, P < 0.05). Among urban adolescents, serum B12 was associated with BMI (ß = -0.08, P < 0.05) and adjusted dietary vitamin B12 intake (ß = 0.14, P < 0.001). Serum vitamin B12 levels were found to be lower in rural females (ß = -0.12, P = 0.030) and urban males (ß: 0.11, P < 0.001) compared to their respective contemporaries. CONCLUSIONS: Vitamin B12 deficiency was higher among rural school-going adolescents. Boys had a higher B12 deficiency than girls. Inverse associations of serum B12 with adiposity indices were observed. Serum B12 levels were positively associated with dietary vitamin B12 intake.

Impact of weekly iron folic acid supplementation with and without vitamin B12 on anaemic adolescent girls: a randomised clinical trial.

BACKGROUND/OBJECTIVES: In India, approx. 70% of the adolescent girls are anaemic (haemolgobin <120 g/l). The present study was a supervised randomised double-blind clinical trial conducted among adolescent girls (11-18 years) to assess and compare the impact of weekly iron folic acid (IFA) supplementation with or without vitamin B12 on reduction in the prevalence of anaemia and on blood/serum levels of haemoglobin, serum ferritin, folic acid and vitamin B12. SUBJECTS/METHODS: Community-based randomized controlled trial was carried out in Kirti Nagar slums of West Delhi. A total of 446 mild (100-119 g/l) and moderate (70-99 g/l) anaemic volunteer adolescent girls were identified and randomised into two groups. Weekly supervised supplementation was given for 26 weeks: Group A (n=222): iron (100 mg), folic acid (500 mcg) and placebo; Group B (n=224): iron (100 mg), folic acid (500 mcg) and cyanocobalamin (500 mcg for 6 weeks and 15 mcg for 20 weeks). Haemoglobin, serum ferritin, folic acid and vitamin B12 levels were assessed at baseline and after intervention. A total of 373 subjects completed 26 weeks of supplementation successfully. RESULTS: The mean haemoglobin increased from 106.7±11.2 g/l and 108.9±8.91 g/l in Group A and Group B at baseline to 116.4±10.8 g/l (P<0.001) and 116.5±10.26 g/l (P<0.001) at post-intervention, respectively, with the reduction in the prevalence of anaemia by 35.9% in Group A and 39.7% in Group B (P>0.05). A total of 63.3% participants had deficient vitamin B12 levels (<203 pg/ml) at baseline, which reduced to 40.4% after intervention with cyanocobalamin, whereas no change was observed in vitamin B12 status in the other group. Significant reduction (P=0.01) in the prevalence of serum ferritin deficiency (<15 ng/ml) was observed in the group supplemented with vitamin B12 (from 36.5 to 6.4%) as compared with the other group supplemented with only IFA (from 39.1 to 15.2%). CONCLUSIONS: IFA supplementation with or without vitamin B12 is an effective measure to cure anaemia. Although addition of vitamin B12 had similar impact on improving haemoglobin status as IFA alone, it resulted in better ferritin status. Hence, more multi-centre studies with a longer duration of supplementation or higher dose of vitamin B12 may be undertaken to assess the possible impact of vitamin B12 on improving haemoglobin levels in the population.

Physicochemical properties and sensory evaluation of fructoligosaccharide enriched cookies.

Short dough cookies were enriched with fructoligosaccharide (FOS), a prebiotic soluble fiber and a low calorie sweetener, at levels of 40%, 60%, and 80% sugar replacement basis. Cookies were analyzed for diameter, height, spread ratio, hardness, moisture and acidity of the extracted fat. The mean peak force at 0 month was determined to be 7139 ± 166 g, 7109 ± 75 g, 6970 ± 24 g and 6538 ± 128 g for control (100% sucrose), 40%, 60% and 80% sugar replacement levels cookies respectively. The spread ratio of control cookies was found to be 4.400 and that of FOS based cookies at 40%, 60% and 80% sugar replacement levels was found to be 4.520, 4.983 and 5.205, respectively. Sensory data on a 9 point hedonic scale indicated that the panelists liked FOS cookies (up to 60% sugar replacement) over control cookies because of improved color, texture and appearance. The total fiber content (including oligofructose) of cookies (60% sugar replacement) was 12.1%. As per FDA these cookies can be categorized as 'Good Source' of fiber. Thus, FOS appears to be suitable as a partial replacer of sucrose up to 60% providing increase in the dietary fiber and reduction in the caloric content of cookies.

Nutrient interaction in relation to glycaemic and insulinaemic response.

Although it is known that protein, fat and fibre reduce the postprandial glycaemia following an oral carbohydrate load, the nature and extent of interaction of different nutrients with one another in this respect is not well understood. The present study was designed to explore systematically the glycaemic and insulinaemic response to glucose (G) alone, or in combination with one or more of the following: casein (CS), maize oil (MO), cellulose (CL) and pectin (P). Besides 100 g G, eleven isoenergetic and six isocarbohydrate meals were studied on healthy adult males using an incomplete block design. Addition of other nutrients to G led to a lowering of the glycaemic response. The lowest glycaemic responses were seen in case of meals containing the largest number of nutrients. P was more effective in reducing postprandial glycaemia than CL. As in case of glycaemic response, low insulinaemic responses were also associated with P-containing meals, and meals containing the largest number of nutrients. But unlike in case of glycaemic response, there was a tendency for elevation of the insulinaemic response in case of CL-containing meals. The degree of attenuation of glycaemic response observed with meals containing several nutrients was roughly predictable on the basis of the attenuation observed with meals in which only one nutrient had been added at a time to G. But the glycaemic response of natural foods is unlikely to be predictable on the basis of their nutrient composition because of the overriding influence of several other factors such as physical form, cooking, processing, storage and antinutrient content of the food.

Modulation of postprandial glycaemia and insulinaemia by dietary fat.

The present study was designed to examine the effect of corn oil (Co) on postprandial glycaemia and insulinaemia when ingested with glucose (G), casein (Cs), cellulose (Cl) and pectin (P) in various combinations. The study was conducted on six healthy male volunteers, on each of whom six meal tolerance tests were performed. The meals were isocaloric and consisted of G; G and Co; G, Co and Cs; G, Co and P; G, Co, Cs and P; and G, Co, Cs and Cl. The meals were administered after an overnight fast. In addition to a fasting blood sample, blood was collected 0.5, 1.0, 1.5 and 2.0 h after ingestion for measurement of serum glucose and insulin levels. The glycaemic response to GCo was comparable to that to G, but the insulinaemic response was significantly lower. The glycaemic response to GCoCs was significantly lower than that to G but the insulinaemic response to both was comparable. The cellulose containing meal GCoCsCl showed a further reduction in the glycaemic response but not in the insulinaemic response. The pectin containing meals GCoP and GCoCsP gave the lowest glycaemic and insulinaemic responses, the responses to the latter being lower. Corn oil by itself has only a modest effect on the postprandial metabolic response to glucose. Addition of protein and fibre, specially pectin, leads to significant attenuation of glycaemic and insulinaemic responses.

Nutrient interaction in relation to glycaemic response in isocarbohydrate and isocaloric meals.

The present study was designed to examine the effect of casein (Cs) on postprandial glycaemia when ingested with glucose (G) alone or in combination with corn oil (Co), cellulose (Cl) or pectin (P). The study was conducted on a pool of ten healthy male volunteers in two sets of five volunteers each. The meals administered in the two sets were similar in composition but were isocarbohydrate (100 g G) in one set, and isocaloric (400 kcal) in another set. The meals in each set consisted of G, G Cs, G Cs Co, G Cs Cl and G Cs P. Each of the five volunteers in a given set underwent five meal tolerance tests (MTT), once with each meal, in a Latin Square design. During the MTT, the meal was administered after an overnight fast. In addition to a fasting venous blood sample, blood was collected 0.5, 1.0, 1.5 and 2.0 h after ingestion for measurement of serum glucose and insulin levels. In both sets, the highest glycaemic response was that to G. In the isocarbohydrate set, G Cs gave a significantly lower glycaemic and insulinaemic response than G. Further addition of Co made no essential difference but both the fibre containing meals gave significantly lower glycaemic responses. The insulinaemic response was attenuated only in case of G Cs P but not in case of G Cs Cl. In the isocaloric set, Cs as G Cs was observed to stimulate insulin secretion rather than attenuate postprandial glycaemia G Cs Co gave a reduction in glycaemic as well as insulinaemic response as compared to G. Both fibre containing meals led to further reduction in both responses, P being somewhat more effective than Cl. Addition of other nutrients to G, in general, reduces postprandial glycaemia.

Modulation of postprandial glycaemia and insulinaemia by cellulose in mixed nutrient combinations.

The present study was designed to examine the effect of cellulose (CL) on postprandial glycaemia and insulinaemia when ingested with glucose (G), casein (CS) and maize oil (CO) in various combinations. The study was conducted on five healthy male volunteers, on each of whom five meal tolerance tests were performed. The meals were isoenergetic and consisted of G; G and CL; G, CS and CL; G, CO and CL; G, CS, CO and CL. The meals were administered after an overnight fast. In addition to a fasting venous blood sample, blood was collected 0.5, 1.0, 1.5 and 2.0 h after ingestion for measurement of serum glucose and insulin levels. The glycaemic response to G + CS + CL and G + CS + CO + CL was significantly lower, while the insulinaemic response to G + CL was significantly higher than that to G. Addition of CL to G did not alter the glycaemic response, but accentuated the insulinaemic response. Further addition of CS in isoenergetic meals attenuated the glycaemic response, which may be because of a reduction in the amount of G in the meals. Like CS, CL also seemed to have an insulinotropic effect. The mechanism of the insulinotropic effect of CL cannot be deduced from the present study, but it is possible that like G, CL also stimulates gastric inhibitory peptide (GIP) secretion from the duodenum, which in turn stimulates insulin secretion.

Modulation of postprandial glycaemia and insulinaemia by pectin in mixed nutrient combinations.

The present study was designed to examine the effect of pectin (P) on postprandial glycaemia and insulinaemia when ingested with glucose (G), casein (Cs) and corn oil (Co) in various combinations. The study was conducted on five healthy male volunteers, on each of whom five meal tolerance tests were performed. The meals were isocaloric and consisted of G; G and P; G, Cs and P; G, Co and P; and G, Cs, Co and P. The meals were administered after an overnight fast. In addition to a fasting blood sample, blood was collected 0.5, 1.0, 1.5 and 2.0 h after ingestion for measurement of serum glucose and insulin levels. The glycaemic and insulinaemic response to GP did not differ significantly from that to G. All the other meals, viz. GCsP, GCoP and GCsCoP, gave a significant reduction in postprandial glycaemia as compared to G. The corn oil containing meals, viz. GCoP and GCsCoP, in addition, gave a significant reduction in postprandial insulinaemia as compared to G. Pectin alone is not a dependable dietary constituent for reducing postprandial glycaemia. Its combination with protein and fat significantly lowers the postprandial glycaemic as well as insulinaemic response to orally administered glucose.

Nutrient composition is a poor determinant of the glycaemic response.

1. The glycaemic response of healthy males to potato, bread, rice and green gram (Phaseolus aureus Roxb.) was compared with that to meals equivalent to these foods in terms of carbohydrate, protein, fat and fibre content, but made up of maize flour, casein, maize oil and ispaghula husk. 2. Natural foods led to a higher postprandial glycaemia than their respective equivalents, but the difference was significant only in the case of potato at 0.5 h (P less than 0.05). 3. The insulin response, studied only in the case of rice and green gram, followed a trend similar to the glycaemic response but the differences between natural foods and equivalents were even more marked. 4. A food is more than the sum of its major nutrients. Several poorly understood factors may contribute to the glycaemic response to a food. In addition to the quantity of nutrients, the response may be the result of the specific type of nutrients, non-nutrient chemicals and anti-nutrients composing the food, and their unique physical arrangement within the food.