Skip to main content Accessibility help

Serum folate and vitamin B12 status in young Brazilian children

  • Lara LS Silva (a1), Wafaie W Fawzi (a2), Marly A Cardoso (a1) and for the ENFAC Working Group (a1) (a2)



To assess the nutritional status of folate and vitamin B12 with anaemia in young children.


A cross-sectional study was conducted at the primary health-care centres of four Brazilian cities. Folate and vitamin B12 were assessed by fluoroimmunoassay. Multilevel Poisson regression models were used to explore the association of folate and vitamin B12 status in relation to anaemia in young children.




Children (n 460) aged 11 to 15 months.


The median (interquartile range) of serum folate was 39·7 (28·8–55·3) nmol/l and only four children presented with folate deficiency (<10 nmol/l). Surprisingly, 30·9 % of children presented with serum folate concentrations above the upper limit of detectable values by the commercial kit used for analysis. The frequency of vitamin B12 deficiency (<148 pmol/l) was 15 % and it was inversely associated with the highest tertile of serum folate concentrations (P<0·001). Having high serum folate concentration (≥50·1 nmol/l) and vitamin B12≥148 pmol/l was associated with lower frequency of anaemia in these children (prevalence ratio=0·53; 95% CI 0·30, 0·92).


High frequency of elevated serum concentration of folate was found among young Brazilian children and 15 % of them had vitamin B12 deficiency. The combination of high serum folate and normal vitamin B12 status was associated with a lower frequency of anaemia in these children. Improvements in the current strategies to promote healthy food-based complementary feeding along with prevention and control of micronutrient deficiencies are recommended to improve children’s health.


Corresponding author

*Corresponding author: Email


Hide All

Members of the ENFAC Working Group are listed in the Appendix.



Hide All
1. Mahmood, L (2014) The metabolic processes of folic acid and vitamin B12 deficiency. J Health Res Rev 1, 59.
2. Shane, B (2008) Folate and vitamin B12 metabolism: overview and interaction with riboflavin, vitamin B6, and polymorphisms. Food Nutr Bull 29, 516.
3. Allen, LH (2008) Causes of vitamin B12 and folate deficiency. Food Nutr Bull 29, Suppl. 2, S20S34.
4. Garrett, GS & Bailey, LB (2018) A public health approach for preventing neural tube defects: folic acid fortification and beyond. Ann N Y Acad Sci 1414, 4758.10.1111/nyas.13579
5. Ng’eno, BN, Perrine, CG, Whitehead, RD Jr et al. (2017) High Prevalence of vitamin B12 deficiency and no folate deficiency in young children in Nepal. Nutrients 9, 72.10.3390/nu9010072
6. Cuevas-Nasu, L, Mundo-Rosas, V, Shamah-Levy, T et al. (2012) Prevalence of folate and vitamin B12 deficiency in Mexican children aged 1 to 6 years in a population-based survey. Salud Publica Mex 54, 116124.
7. Villamor, E, Mora-Plazas, M, Forero, Y et al. (2008) Vitamin B-12 status is associated with socioeconomic level and adherence to an animal food dietary pattern in Colombian school children. J Nutr 138, 13911398.
8. Bjørke-Monsen, AL & Ueland, PM (2011) Cobalamin status in children. J Inherit Metab Dis 34, 111119.10.1007/s10545-010-9119-1
9. Barnabé, A, Aléssio, ACM, Bittar, LF et al. (2015) Folate, vitamin B12 and homocysteine status in the post-folic acid fortification era in different subgroups of the Brazilian population attended to at a public health care center. Nutr J 14, 19.10.1186/s12937-015-0006-3
10. Cobayashi, F, Tomita, LY, Augusto, RA et al. (2015) Genetic and environmental factors associated with vitamin B12 status in Amazonian children. Public Health Nutr 18, 22022210.
11. Britto, JC, Cançado, R & Guerra-Shinohara, EM (2014) Concentrations of blood folate in Brazilian studies prior to and after fortification of wheat and cornmeal (maize flour) with folic acid: a review. Rev Bras Hematol Hemoter 36, 275286.
12. Selhub, J & Rosenberg, IH (2016) Excessive folic acid intake and relation to adverse health outcome. Biochimie 126, 7178.10.1016/j.biochi.2016.04.010
13. Paul, L & Selhub, (2017) Interaction between excess folate and low vitamin B12 status. Mol Aspects Med 53, 4347.
14. Arsenault, JE, Mora-Plazas, M, Forero, Y et al. (2009) 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, 842849.10.1038/ejcn.2008.50
15. Cardoso, MA, Augusto, RA, Bortolini, GA et al. (2016) Effect of providing multiple micronutrients in powder through primary healthcare on anemia in young Brazilian children: a multicentre pragmatic controlled trial. PLoS One 11, e0151097.
16. Lohman, TG, Roche, AF & Martorel, R (1988) Anthropometric Standardization Reference Manual. Champaign, IL: Human Kinetics Books.
17. World Health Organization (2006) WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva: WHO.
18. de Onis, M & Lobstein, T (2010) Defining obesity risk status in the general childhood population: which cut-offs should we use? Int J Pediatr Obes 5, 458460.10.3109/17477161003615583
19. Benoist, B (2008) Conclusions of a WHO Technical Consultation on folate and vitamin B12 deficiencies. Food Nutr Bull 29, Suppl. 2, S238S244.
20. Green, R, Allen, LH, Bjørke-Monsen, AL et al. (2017) Vitamin B12 deficiency. Nat Rev Dis Primers 3, 17040.
21. World Health Organization (2011) Haemoglobin Concentrations for the Diagnosis of Anaemia and Assessment of Severity. Geneva: WHO.
22. World Health Organization (2001) Iron Deficiency Anaemia: Assessment, Prevention and Control. A Guide for Programme Managers. Geneva: WHO.
23. Thurnham, DI, McCabe, LD, Haldar, S et al. (2010) Adjusting plasma ferritin concentrations to remove the effects of subclinical inflammation in the assessment of iron deficiency: a meta-analysis. Am J Clin Nutr 92, 546555.10.3945/ajcn.2010.29284
24. Cardoso, MA, Scopel, KK, Muniz, PT et al. (2012) Underlying factors associated with anemia in Amazonian children: a population-based, cross-sectional study. PLoS One 7, e36341.
25. Jones, KM, Ramirez-Zea, M, Zuleta, C et al. (2007) Prevalent vitamin B-12 deficiency in twelve-month-old Guatemalan infants is predicted by maternal B-12 deficiency and infant diet. J Nutr 137, 13071313.
26. Crider, KS, Bailey, LB & Berry, RJ (2011) Folic acid food fortification – its history, effect, concerns and future directions. Nutrients 3, 370384.
27. Sangalli, CN, Rauber, F & Vitolo, MR (2016) Low prevalence of inadequate micronutrient intake in young children in the south of Brazil: a new perspective. Br J Nutr 116, 890896.
28. Colapinto, CK, O’Connor, DL, Sampson, M et al. (2016) Systematic review of adverse health outcomes associated with high serum or red blood cell folate concentrations. J Public Health (Oxf) 38, e84e97.
29. Rogers, LM, Boy, E, Miller, JW et al. (2003) High prevalence of cobalamin deficiency in Guatemalan schoolchildren: associations with low plasma holotranscobalamin II and elevated serum methylmalonic acid and plasma homocysteine concentrations. Am J Clin Nutr 77, 433440.
30. Bruyn, E, Gulbis, B & Cotton, F (2013) Serum and red blood cell folate testing for folate deficiency: new features? Eur J Haematol 92, 354359.
31. World Health Organization (2012) Serum and Red Blood Cell Folate Concentrations for Assessing Folate Status in Populations. Geneva: WHO.


Serum folate and vitamin B12 status in young Brazilian children

  • Lara LS Silva (a1), Wafaie W Fawzi (a2), Marly A Cardoso (a1) and for the ENFAC Working Group (a1) (a2)


Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed