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Poor folate status predicts persistent diarrhea in 6- to 30-month-old north Indian children
Authors:Manger Mari S  Taneja Sunita  Strand Tor A  Ueland Per M  Refsum Helga  Schneede Jørn  Nygård Ottar  Sommerfelt Halvor  Bhandari Nita
Institution:Institute of Medicine, University of Bergen, Bergen, Norway.
Abstract:Poor micronutrient status is associated with diarrheal illness, but it is not known whether low folate and/or cobalamin status are independent risk factors for diarrhea. We measured the association between plasma folate and cobalamin and subsequent diarrheal morbidity in a prospective cohort study of 2296 children aged 6-30 mo in New Delhi, India. Plasma concentrations of folate, cobalamin, total homocysteine (tHcy), and methylmalonic acid were determined at baseline. Whether a child had diarrhea was recorded during weekly visits in a 4-mo zinc supplementation trial. Diarrhea episodes lasting <7, ≥7, and ≥14 d were classified as acute, prolonged, and persistent, respectively. There was a total of 4596 child periods with acute, 633 with prolonged, and 117 with persistent diarrhea during follow-up. Children with plasma folate concentrations in the lowest quartile had higher odds of persistent diarrhea than children in the other quartiles adjusted OR = 1.77 (95% CI = 1.14, 2.75); P = 0.01]. This effect differed between boys adjusted OR = 2.51 (95% CI = 1.47, 4.28)] and girls adjusted OR = 1.03 (95% CI = 0.53, 2.01); P-interaction = 0.030]. We found a small but significant association between high plasma tHcy concentration and acute diarrhea adjusted OR = 1.14 (95% CI = 1.04, 1.24); P = 0.006]. Plasma cobalamin concentration was not a predictor of diarrheal morbidity. In conclusion, poor folate status was an independent predictor of persistent diarrhea in this population.
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