Vitamin B12 deficiency in India


Note: This is not a complete overview of all studies.

Update August 2024:

A cross-sectional study conducted in two rural areas in Ambala District, Haryana, northern India (conducted in 2017 - yes, it took seven years for the results to be publish) found a high prevalence of vitamin B12 deficiency.
  • The study included 775 women [I think; some of the tables say 755, which I think is a typo] of reproductive age (18-49 years old).
  • The prevalence of vitamin B12 deficiency (serum B12 <200 pg/mL) and of "marginal deficiency" (≥200 pg/mL and ≤300 pg/mL) for the entire sample (i.e., all participants included) was 57.7% (95% CI: 53.9, 61.4) and 23.5% (95% CI: 20.4, 26.9), respectively.
  • Among the subgroup of never-married women the prevalence of vitamin B12 deficiency was 78.7%.
  • Among the subgroup of lacto-vegetarian women (88.7% of the total sample) the prevalence of vitamin B12 deficiency was 58.8%.
  • The women who took a vitamin B12 supplement (apparently only 20 women - the numbers given are not clear but probably 20 out of 775) had a mean serum vitamin B12 level of ~526 pg/mL (i.e., adequate status).
  • Among all study participants, the percentage of lacto-vegetarians (referred to as "vegetarian" by the authors) was 86.5%, and the percentage of ovo-lacto-vegetarians (referred to as "eggetarian" by the authors) was 4.6%. The remainder (8.9%) were non-vegetarians.
  • Even the non-vegetarians had a prevalence of vitamin B12 deficiency of 50.8%.
  • The prevalence of folate deficiency was also high [probably indicating a relatively low intake of leafy vegetables and legumes] [Das et al. 2024].
Opinion: In my opinion, the study again confirms that vitamin B12 fortification of flour or other staple foods is urgently required in India.



ૐ


Update May 2024:

Data from a study in northern India (2014-2016) show that >90% of lacto-vegetarian women were categorized as being vitamin B12-deficient [Ganie et al. 2024].

More details:

  • Data are from a "hospital based, twin-center, cross-sectional observational study enrolled subjects from two Northern Indian cities between January 2014 and December 2016".
  • Diet definitions: "The women (PCOS n = 112; healthy, n = 186) who strictly consumed plant-based diets with no egg, fish, poultry, and meat were considered vegetarian while as women (PCOS, n = 104; healthy, n = 148) who consumed meat/chicken/fish/egg at last 5 days a week in the preceding 1 year were considered as nonvegetarian".
  • "Using 4cB12 [combined biomarker including vitamin B12, homocysteine, MMA, and holo-transcobalamin], prevalence of VB12D [vitamin B12 deficiency] is discerned in 54.4% (PCOS: 72.1%; healthy 36.5%) and 93.4% (PCOS: 95.9%; healthy: 91.9%) among nonvegetarians and vegetarians, respectively.
  • "
    "


ૐ



[random photo, southern India, 2007]


Mittal et al. (2017):

A new study from New Delhi shows that „[t]here is a high prevalence of vitamin B12 deficiency in Indian infants and their mothers. There is an urgent need to supplement our population with vitamin B12, and the best time to do this would be antenatal.“
 
[For vegetarians the best time to do this would be during all stages of the life cycle, I would say.]

Summary

  • Background: „Vitamin B12 deficiency in early life can adversely affect the growth of developing brain with myriad of neurodevelopmental manifestations. At this age, the deficiency is usually the result of low maternal levels.“
  • Study participants: „exclusively breast-fed Indian infants aged 1 to 6 months and their mothers“ (n = 100)
  • Results: 57% of the babies and 46 % of the mothers had B12 deficiency.
  • „Normal“ serum B12 levels were defined as 200–700 pg/mL in this study.
  • More info: „In an infant born to deficient mother, not only are the blood levels of B12 low, but the liver stores of the vitamin are also inadequate. Further, a [vitamin B12] deficient mother is likely to produce breast milk having low levels of the vitamin. Even though a deficient mother may not exhibit any hematological or neurological symptoms of B12 deficiency for several years, her exclusively breast-fed infant may develop symptoms as early as 3 weeks of age. These are often subtle and difficult to detect because of the wide variation in the normal development in this age group. Such infants may have failure to thrive, irritability, apathy, anorexia [don’t want to eat], refusal to solid feeds, delay and regression of neurological development, hypotonia [baby apears weak and „floppy“], seizures, and pancytopenia [~anemia].“
  • Of the babies <3 months old 62 % had B12 deficiency.
  • „Two infants had levels less than 50 pg/mL with the lowest being 6.6 pg/mL [!]“
  • 10% of the mothers were vegans* (or ~vegans) [!], 19 % lacto-vegetarians, 17 % lacto-ovo-vegetarians, and 54 % nonvegetarians (= 100 women in total)
  • 69% of the babies with vegetarian mothers, and 52 % of the babies with nonvegetarian mothers were B12 deficient.
  • „Of the 100 mothers, 46 % were deficient in B12 and all were asymptomatic.“
*I asked the corresponding author. 

The authors of this new study have also listed severeal other studies on the topic. I didn’t check the original sources. This table summarizes the studies:



Studies on vitamin B12 deficiency in India
City/region
Patients
Prevalence of
vitamin B12 deficiency
Year
New Delhi
(this study here, by Mittal et al.)
- exclusively breast-fed babies
(1–6 months old)
- their mothers
(each: n = 100)
babies: 57 %
mothers: 46 %
2017
Pune (Pune maternal nutrition study)
pregnant mothers
(at 28 weeks of pregnancy)
71 % low serum B12
(>90 % had high urinary MMA)
2008
Mysore
mothers
42 %
2015
Bangalore
pregnant women
(before 14 weeks of pregnancy)
50 %
2014
Vellore, South India
women (n = 1000)
52 %
1973
Rural Haryana, North India
pregnant women
74 %
2007
Pune
adults (n = 224)
47 %
(73 % had high MMA)
2001
Pune
middle-aged men
(n = 441)
67 % had low serum B12
2006
New Delhi
infants (6–30 months old)
(n = 2261)
28 %
2007
Pune
toddlers (Ø 2.4 years)
(n = 51)
(urban slum population)
14 %
2008




Reference:

  • Mittal M, Bansal V, Jain R, Kumar Dabla P: Perturbing status of vitamin B12 in Indian infants and their mothers. Food and Nutrition Bulletin 38(2): 209–215 (2017), doi: 10.1177/0379572117697535, https://pubmed.ncbi.nlm.nih.gov/28513265/