Vitamin B12 absorption in protein—calorie malnourished children and during recovery: influence of protein depletion and of diarrhea

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Abstract
The absorption of 57Co-vitamin B12 was studied by means of the Schilling test in 25 severely protein—calorie malnourished children upon admission to the hospital. In 10 of these, the effect of simultaneous intrinsic factor was evaluated, and absorption studies were repeated after 12 days of therapeutic diet. Ten fully recovered children served as controls. Results indicate that in severe PCM, vitamin B12 absorption is low and does not improve with intrinsic factor administration (the mean ± sd urinary excretion of 57Co-B12 as percent of dose without intrinsic factor was 12.3 ± 9.5; with intrinsic factor, it was 8.4 ± 7.3). During early recovery, the percent urinary excretion of 57Co rose to 17.0 ± 10.1. These tests were done with the administration of intrinsic factor. The values obtained in fully recovered children were 31.4 ± 9.7; these are similar to those obtained in children with pernicious anemia to whom intrinsic factor is given. In severely malnourished children and during their early recovery, diarrhea produces a marked drop in vitamin B12 absorption, but children without diarrhea in the same clinical stages will absorb subnormal amounts of vitamin B12. Vitamin B12 absorption correlates with the creatinine height index (r = 0.493), suggesting that the degree of protein depletion influences vitamin B12 absorption. These results are discussed in the light of the possible role the terminal ileum might have in the altered bile salt metabolism described in PCM children and in the presence of diarrhea.