Folic Acid and Vitamin B12 in Young Indian Children
Hypothesis: Supplementation of two recommended daily allowances (RDA) of folic acid with or without simultaneous administration of vitamin B12 reduces the rates of acute lower respiratory tract infections (ALRI), clinical pneumonia and diarrhea.
Design/Methods We will conduct a preventive randomized placebo controlled clinical trial of folic acid and vitamin B12 supplementation in 1000 children aged 6 to 30 months living in a low to middle-income socioeconomic setting in New Delhi, India. Children aged 6-30 months will be identified through a survey. Eligible and willing Children aged 6-30 months will be randomized to 4 treatment groups. Trial to enrollment informed consent will be obtained by the Study Physician/Supervisor. At enrollment a baseline form will be filled and the child weight and length taken. The baseline blood samples will be collected. The supplements will be given daily for 6 months. Morbidity will be ascertained through biweekly home visits by field workers.
|Diarrhea Pneumonia||Dietary Supplement: Folic Acid Dietary Supplement: Vitamin B12 Dietary Supplement: Placebo Dietary Supplement: Folic acid and vitamin B12||Phase 2|
|Study Design:||Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Quadruple (Participant, Care Provider, Investigator, Outcomes Assessor)
Primary Purpose: Prevention
|Official Title:||Routine Administration of Folic Acid and Vitamin B12 to Prevent Childhood Infections in Young Indian Children|
- Number of episodes diarrhea (all, severe, prolonged) and pneumonia (ALRI, Clinical pneumonia) [ Time Frame: 6 months ]
- Prevalence of diarrhea [ Time Frame: 6 months ]
- Growth (length for age, weight for age, and length for weight) [ Time Frame: 6 month ]
- Adverse events (vomiting and gastric discomfort) [ Time Frame: 6 months ]
- Changes in folate, vitamin B12, methyl malonic acid, and homocysteine concentration [ Time Frame: 6 months ]
- Developmental Milestones [ Time Frame: End study, i.e. after 6 months of vitamin B12 and/or folic acid administration ]Developmental milestones. The developmental milestones will be measured using the ASQ-3. ASQ-3 is an easily administered and comprehensive checklist consisting of 30 items measuring skills in 5 different domains; Communication, Gross Motor, Fine Motor, Personal-Social and Problem-Solving. The questionnaires are divided into two-month intervals for use with children 4-60 months of age, and scores are normed to indicate whether children are developing age-appropriately.
- Measure the association between pneumonia incidence and the plasma mannose binding lectin (MBL) concentration [ Time Frame: Baseline blood samples ]
- Measure the exposure to Cryptosporidium spp [ Time Frame: Baseline blood samples ]We will measure the exposure to Cryptosporidium spp. in Indian children aged 6-30 months by measurement of antibodies to recombinant gp15, a conserved surface protein in plasma samples taken at baseline.
- Measure the association between the antibody response to Cryptosporidium and plasma MBL [ Time Frame: Baseline blood samples ]
- Compare the change in plasma MBL between the intervention groups [ Time Frame: 6 months ]We will compare the change in plasma MBL between those who have been given 2 RDA of vitamin B12 and/or folic acid with those who were given placebo in a subsample of 256 children.
- Vitamin D status [ Time Frame: Baseline blood samples ]We will measure vitamin D (25-hydroxy vitamin D) in all children at baseline to describe the vitamin D status and the proportion with vitamin D deficiency.
- Vitamin D status and the risk for respiratory infections [ Time Frame: Baseline samples and 6 months follow up ]We will measure the vitamin D status at baseline and assess to what extent it predicts the risk of subsequent respiratory tract infections over the next 6 months.
|Study Start Date:||January 2010|
|Study Completion Date:||September 2011|
|Primary Completion Date:||September 2011 (Final data collection date for primary outcome measure)|
Placebo Comparator: A
Placebo dietary supplement
Dietary Supplement: Placebo
Placebo with no active ingredients
Dietary Supplement: Folic Acid
150µgm/day for 6 months in children older than 11 months and 80µgm in 6 to 11 months.
Other Name: Folate
Dietary Supplement: Vitamin B12
1.8µgm/day for 6 months in children older than 11 months and 0.5µgm in 6 to 11 months.
Other Name: Cobalamin
Folic acid and Vitamin B12
Dietary Supplement: Folic acid and vitamin B12
Folic acid 150µgm/day for 6 months in children older than 11 months and 80µgm in 6 to 11 months vitamin B12 1.8µgm/day for 6 months in children older than 11 months and 0.5µgm in 6 to 11 months.
Pneumonia and diarrhea are among the leading causes of poor health and death in young children of developing countries.
Many of these children have inadequate intakes of several vitamins and minerals. Folate and vitamin B12 are important for normal function of the immune system. Deficiencies of these vitamins are often part of general malnutrition and might be responsible for the excess morbidity and mortality seen in malnourished children. In a recent cohort study in almost 2,500 Indian children we demonstrated that those with poor folate status had higher rates of diarrhea and pneumonia. This study also showed that children that were not breastfed had poor folate status and our analyses suggested that the effect of breastfeeding in preventing respiratory and gastrointestinal infections could be explained by the folate content of breast milk. The finding that poor folate status is related to increased susceptibility to childhood infections needs to be confirmed in well conducted clinical trials in populations where folate deficiency is prevalent.
This trial aims to examine whether daily supplementation of 2 recommended doses of folate or vitamin B12 or both will lessen the incidence of acute lower respiratory tract infections and diarrhea. We will also measure if the supplementation improves the weight and length of supplemented children.
Please refer to this study by its ClinicalTrials.gov identifier: NCT00717730
|Society for Essential Health Action and Training|
|New Delhi, Delhi, India|
|Principal Investigator:||Tor A Strand, MD, PhD||University of Bergen|
|Principal Investigator:||Sunita Taneja, MBBS, PhD||Society for Essential Health Action and Training|