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Background: Dietary vitamin B12 (B12) deficiency is common in Indians. Long-term compliance to tablet supplementation is poor in asymptomatic individuals. Objective: To study efficacy of B12 fortified nutrient bar and yogurt in improving plasma B12 concentrations in children and adults. Methods: Two double-blind, placebo-controlled directly observed therapy randomized controlled trials were conducted for 120 days: (1) Healthy children (10-13 years) were fed nutrient bar fortified with B12 (2 μg), multiple micronutrients B12 (1.8 μg) or placebo. (2) Healthy adults (18-50 years) were fed yogurt fortified with B12 (2 μg) or Propionibacterium (1 × 108 cfu/g) or placebo. B12, folate, homocysteine, and hemoglobin concentrations were measured before and post intervention. Results: We randomized 164 children and 118 adults; adherence was 96% and 82%, respectively. In children, B12 fortified bars increased B12 concentrations significantly above baseline (B12 alone +91 pmol/L, B12+ multiple micronutrients +82 pmol/L) compared to placebo. In adults, B12 fortified yogurt increased B12 significantly (+38 pmol/L) but Propionibacterium and placebo did not. In both trials, homocysteine fell significantly with B12 supplementation. Rise of B12 and fall of homocysteine were influenced by dose of B12 and folic acid. There was no significant difference in change of anthropometry and hemoglobin between groups. Conclusions: B12 fortified foods are effective in improving B12 status in Indian children and adults. They could be used to improve B12 status in the national programs for children, adolescents, and women of reproductive age. They could also be used as over-the-counter products.

To: 1. Assess muscle function (MF) of rural Indian children (6-11y, n=232), using Jumping Mechanography (JM) and hand dynamometer, 2. Investigate gender differences, 3. Identify determinants of MF.Data on anthropometry, muscle mass%, diet, physical activity, sunlight exposure, MF (maximum relative power Pmax/mass, maximum relative force Fmax/BW by JM; relative grip strength (RGS) by hand dynamometer) were collected. Pearson's correlation and hierarchical linear regression was performed.Pmax/mass, Fmax/BW and RGS of the group were 31.7±5.0W/kg, 3.0±0.3 and 0.4±0.1 (mean±SD), respectively. The Pmax/mass Z-score was -1.1±0.9 and Fmax/BW Z-score was -0.9±1 (mean±SD) which was significantly lower than the machine reference data (MF was lower than in western counterparts. To optimize MF of rural Indian children, focus should be on improving muscle mass, ensuring adequate dietary protein, and increasing physical activity, especially in girls.

Grip strength (GS) is used as an index of overall health in children. The objectives of our study were to assess GS, gender differences in GS in 9 -18 year old urban (U) and rural (R) Indian children, study association of GS with body composition (BC) and assess determinants. This was part of a multicentre, cross sectional, school-based study (n=1978, mean age 13.3 ± 2.2 years) from 3 U and R states. Anthropometry, BC, dietary intake, physical activity, sunlight exposure and GS (in Kg) measurements were performed. The mean GS increased with age but plateaued in girls after 12 years; was higher in boys (19.6 ± 9.2) than girls (14.3 ± 5.3) (p < 0.05). Mean GS was higher in U (21.05 ± 9.7) than in R boys (17.8 ± 8.2) (p < 0.05), comparable in U (14.9 ± 5.2) and R girls (13.8 ± 5.5). GS in girls remained lower than boys after adjusting for muscle mass (MM). Difference between boys and girls reduced after body size (BMI) correction, but remained low in girls plateauing after 15 years. MM and age were significant determinants of GS in all children. On addition of lifestyle factors, GS was explained to varied degrees, the least in U girls, followed by R girls and R boys and the most in U boys. Conclusion: In boys, nutrition though body size and composition was largely responsible for the differences in GS and in girls, additionally socio-cultural factors also possibly impact GS.

Dietary vitamin BTo study efficacy of BTwo double-blind, placebo-controlled directly observed therapy randomized controlled trials were conducted for 120 days: (1) Healthy children (10-13 years) were fed nutrient bar fortified with BWe randomized 164 children and 118 adults; adherence was 96% and 82%, respectively. In children, BB

BackgroundDietary vitamin B12 (B12) deficiency is common in Indians. It may affect hematologic and neurocognitive systems and maternal deficiency predisposes offspring to neural tube defects and non-communicable disease. Long-term tablet supplementation is not sustainable.ObjectiveTo study efficacy of B12 fortified nutrient bar and yogurt in improving plasma B12 concentrations in children and adults.MethodsTwo double-blind, placebo-controlled randomised directly observed therapy (DOT) trials were conducted: 1. Healthy children (10–13Y) were fed nutrient bar fortified with B12 (2 mcg), multiple micronutrients (B12 1.8 mcg) or placebo for 120 days. 2. Healthy adults (18–50Y) were fed yogurt fortified with B12 (2 mcg) or Propionibacterium (1×108cfu/g) or placebo for 120 days. B12, folate, homocysteine and hemoglobin concentrations and anthropometry were measured before and post intervention.ResultsWe randomised 164 children and 118 adults; adherence was 96% and 82% respectively. In children, B12 fortified bars increased B12 concentrations significantly above baseline (B12 alone: median +91 pmol/l, B12+ multiple micronutrients: +82 pmol/l) compared to placebo. In adults, B12 fortified yogurt increased B12 significantly (median +38 pmol/l) compared to placebo, but Propionibacterium did not. In both trials, homocysteine fell significantly with B12 supplementation. There was no significant difference in different groups in anthropometry and hemoglobin.ConclusionsB12 fortified foods are effective in improving B12 status in Indian children and adults. They could be used to improve vitamin B12 status in the national programs for children, adolescents and women of reproductive age. They could also be used as over the counter products.Brief HighlightsVitamin B12 deficiency is common in India. Culturally acceptable fortified foods will help reduce it. We performed two RCTs (children and adults) with B12 fortified nutrient bar and yogurt at near RDA doses and found significant improvement in B12 status. This has important implications for nutritional policy.