Folic Acid and Vitamin B12 in Young Indian Children

NCT ID: NCT00717730

Last Updated: 2015-07-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE2

Total Enrollment

1000 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-01-31

Study Completion Date

2011-09-30

Brief Summary

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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.

Detailed Description

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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.

Conditions

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Diarrhea Pneumonia

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

FACTORIAL

Primary Study Purpose

PREVENTION

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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A

Placebo dietary supplement

Group Type PLACEBO_COMPARATOR

Placebo

Intervention Type DIETARY_SUPPLEMENT

Placebo with no active ingredients

B

Folic acid

Group Type EXPERIMENTAL

Folic Acid

Intervention Type DIETARY_SUPPLEMENT

150µgm/day for 6 months in children older than 11 months and 80µgm in 6 to 11 months.

C

Vitamin B12

Group Type EXPERIMENTAL

Vitamin B12

Intervention Type DIETARY_SUPPLEMENT

1.8µgm/day for 6 months in children older than 11 months and 0.5µgm in 6 to 11 months.

D

Folic acid and Vitamin B12

Group Type EXPERIMENTAL

Folic acid and vitamin B12

Intervention Type DIETARY_SUPPLEMENT

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.

Interventions

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Folic Acid

150µgm/day for 6 months in children older than 11 months and 80µgm in 6 to 11 months.

Intervention Type DIETARY_SUPPLEMENT

Vitamin B12

1.8µgm/day for 6 months in children older than 11 months and 0.5µgm in 6 to 11 months.

Intervention Type DIETARY_SUPPLEMENT

Placebo

Placebo with no active ingredients

Intervention Type 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.

Intervention Type DIETARY_SUPPLEMENT

Other Intervention Names

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Folate Cobalamin

Eligibility Criteria

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Inclusion Criteria

* Age: 6 to 30 months
* Either sex
* Likely to reside in area for next 6 months

Exclusion Criteria

* Severe systemic illness requiring hospitalization
* Severe malnutrition, i.e. weight for height \< -3 z of the WHO standard for this age group. For ethical reasons these children require micronutrient supplementation and adequate medical care.
* Non consent
* Consuming vitamin supplements that include folic acid and vitamin B12.
* Severe anemia (Hb \< 7 g/dL).
Minimum Eligible Age

6 Months

Maximum Eligible Age

30 Months

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Society for Essential Health Action and Training, New Delhi, India

UNKNOWN

Sponsor Role collaborator

Thrasher Research Fund

OTHER

Sponsor Role collaborator

Tor A. Strand

OTHER

Sponsor Role lead

Responsible Party

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Tor A. Strand

Professor II

Responsibility Role SPONSOR_INVESTIGATOR

Principal Investigators

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Tor A Strand, MD, PhD

Role: PRINCIPAL_INVESTIGATOR

University of Bergen

Sunita Taneja, MBBS, PhD

Role: PRINCIPAL_INVESTIGATOR

Society for Essential Health Action and Training

Locations

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Society for Essential Health Action and Training

New Delhi, National Capital Territory of Delhi, India

Site Status

Countries

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India

References

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Taneja S, Bhandari N, Strand TA, Sommerfelt H, Refsum H, Ueland PM, Schneede J, Bahl R, Bhan MK. Cobalamin and folate status in infants and young children in a low-to-middle income community in India. Am J Clin Nutr. 2007 Nov;86(5):1302-9. doi: 10.1093/ajcn/86.5.1302.

Reference Type BACKGROUND
PMID: 17991639 (View on PubMed)

Strand TA, Taneja S, Bhandari N, Refsum H, Ueland PM, Gjessing HK, Bahl R, Schneede J, Bhan MK, Sommerfelt H. Folate, but not vitamin B-12 status, predicts respiratory morbidity in north Indian children. Am J Clin Nutr. 2007 Jul;86(1):139-44. doi: 10.1093/ajcn/86.1.139.

Reference Type BACKGROUND
PMID: 17616773 (View on PubMed)

Allen LH. Multiple micronutrients in pregnancy and lactation: an overview. Am J Clin Nutr. 2005 May;81(5):1206S-1212S. doi: 10.1093/ajcn/81.5.1206.

Reference Type BACKGROUND
PMID: 15883453 (View on PubMed)

Smith AD, Kim YI, Refsum H. Is folic acid good for everyone? Am J Clin Nutr. 2008 Mar;87(3):517-33. doi: 10.1093/ajcn/87.3.517.

Reference Type BACKGROUND
PMID: 18326588 (View on PubMed)

Sazawal S, Dhingra U, Dhingra P, Hiremath G, Kumar J, Sarkar A, Menon VP, Black RE. Effects of fortified milk on morbidity in young children in north India: community based, randomised, double masked placebo controlled trial. BMJ. 2007 Jan 20;334(7585):140. doi: 10.1136/bmj.39035.482396.55. Epub 2006 Nov 28.

Reference Type BACKGROUND
PMID: 17132678 (View on PubMed)

Tielsch JM, Khatry SK, Stoltzfus RJ, Katz J, LeClerq SC, Adhikari R, Mullany LC, Shresta S, Black RE. Effect of routine prophylactic supplementation with iron and folic acid on preschool child mortality in southern Nepal: community-based, cluster-randomised, placebo-controlled trial. Lancet. 2006 Jan 14;367(9505):144-52. doi: 10.1016/S0140-6736(06)67963-4.

Reference Type BACKGROUND
PMID: 16413878 (View on PubMed)

Fawzi WW, Msamanga GI, Spiegelman D, Urassa EJ, McGrath N, Mwakagile D, Antelman G, Mbise R, Herrera G, Kapiga S, Willett W, Hunter DJ. Randomised trial of effects of vitamin supplements on pregnancy outcomes and T cell counts in HIV-1-infected women in Tanzania. Lancet. 1998 May 16;351(9114):1477-82. doi: 10.1016/s0140-6736(98)04197-x.

Reference Type BACKGROUND
PMID: 9605804 (View on PubMed)

Sazawal S, Black RE, Ramsan M, Chwaya HM, Stoltzfus RJ, Dutta A, Dhingra U, Kabole I, Deb S, Othman MK, Kabole FM. Effects of routine prophylactic supplementation with iron and folic acid on admission to hospital and mortality in preschool children in a high malaria transmission setting: community-based, randomised, placebo-controlled trial. Lancet. 2006 Jan 14;367(9505):133-43. doi: 10.1016/S0140-6736(06)67962-2.

Reference Type BACKGROUND
PMID: 16413877 (View on PubMed)

Fawzi WW, Msamanga GI, Urassa W, Hertzmark E, Petraro P, Willett WC, Spiegelman D. Vitamins and perinatal outcomes among HIV-negative women in Tanzania. N Engl J Med. 2007 Apr 5;356(14):1423-31. doi: 10.1056/NEJMoa064868.

Reference Type BACKGROUND
PMID: 17409323 (View on PubMed)

Tamura T, Yoshimura Y, Arakawa T. Human milk folate and folate status in lactating mothers and their infants. Am J Clin Nutr. 1980 Feb;33(2):193-7. doi: 10.1093/ajcn/33.2.193.

Reference Type BACKGROUND
PMID: 7355792 (View on PubMed)

Khambalia A, Latulippe ME, Campos C, Merlos C, Villalpando S, Picciano MF, O'connor DL. Milk folate secretion is not impaired during iron deficiency in humans. J Nutr. 2006 Oct;136(10):2617-24. doi: 10.1093/jn/136.10.2617.

Reference Type BACKGROUND
PMID: 16988136 (View on PubMed)

Chowdhury R, Taneja S, Kvestad I, Hysing M, Bhandari N, Strand TA. Vitamin D status in early childhood is not associated with cognitive development and linear growth at 6-9 years of age in North Indian children: a cohort study. Nutr J. 2020 Feb 10;19(1):14. doi: 10.1186/s12937-020-00530-2.

Reference Type DERIVED
PMID: 32041632 (View on PubMed)

Kvestad I, Taneja S, Upadhyay RP, Hysing M, Bhandari N, Strand TA. Vitamin B12, Folate, and Cognition in 6- to 9-Year-Olds: A Randomized Controlled Trial. Pediatrics. 2020 Mar;145(3):e20192316. doi: 10.1542/peds.2019-2316. Epub 2020 Feb 4.

Reference Type DERIVED
PMID: 32019814 (View on PubMed)

Winje BA, Kvestad I, Krishnamachari S, Manji K, Taneja S, Bellinger DC, Bhandari N, Bisht S, Darling AM, Duggan CP, Fawzi W, Hysing M, Kumar T, Kurpad AV, Sudfeld CR, Svensen E, Thomas S, Strand TA. Does early vitamin B12 supplementation improve neurodevelopment and cognitive function in childhood and into school age: a study protocol for extended follow-ups from randomised controlled trials in India and Tanzania. BMJ Open. 2018 Feb 22;8(2):e018962. doi: 10.1136/bmjopen-2017-018962.

Reference Type DERIVED
PMID: 29472265 (View on PubMed)

Chowdhury R, Taneja S, Bhandari N, Kvestad I, Strand TA, Bhan MK. Vitamin-D status and neurodevelopment and growth in young north Indian children: a secondary data analysis. Nutr J. 2017 Sep 18;16(1):59. doi: 10.1186/s12937-017-0285-y.

Reference Type DERIVED
PMID: 28923060 (View on PubMed)

Kumar T, Taneja S, Sachdev HPS, Refsum H, Yajnik CS, Bhandari N, Strand TA; Study Group. Supplementation of vitamin B12 or folic acid on hemoglobin concentration in children 6-36 months of age: A randomized placebo controlled trial. Clin Nutr. 2017 Aug;36(4):986-991. doi: 10.1016/j.clnu.2016.07.002. Epub 2016 Jul 18.

Reference Type DERIVED
PMID: 27486122 (View on PubMed)

Kvestad I, Taneja S, Kumar T, Hysing M, Refsum H, Yajnik CS, Bhandari N, Strand TA; Folate and Vitamin B12 Study Group. Vitamin B12 and Folic Acid Improve Gross Motor and Problem-Solving Skills in Young North Indian Children: A Randomized Placebo-Controlled Trial. PLoS One. 2015 Jun 22;10(6):e0129915. doi: 10.1371/journal.pone.0129915. eCollection 2015.

Reference Type DERIVED
PMID: 26098427 (View on PubMed)

Strand TA, Taneja S, Kumar T, Manger MS, Refsum H, Yajnik CS, Bhandari N. Vitamin B-12, folic acid, and growth in 6- to 30-month-old children: a randomized controlled trial. Pediatrics. 2015 Apr;135(4):e918-26. doi: 10.1542/peds.2014-1848.

Reference Type DERIVED
PMID: 25802345 (View on PubMed)

Taneja S, Strand TA, Kumar T, Mahesh M, Mohan S, Manger MS, Refsum H, Yajnik CS, Bhandari N. Folic acid and vitamin B-12 supplementation and common infections in 6-30-mo-old children in India: a randomized placebo-controlled trial. Am J Clin Nutr. 2013 Sep;98(3):731-7. doi: 10.3945/ajcn.113.059592. Epub 2013 Jul 31.

Reference Type DERIVED
PMID: 23902779 (View on PubMed)

Other Identifiers

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RCN172226

Identifier Type: -

Identifier Source: org_study_id

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