The goal of the Finkelstein Laboratory is to elucidate the role of iron, vitamin B12, and folate in the etiology of anemia and adverse pregnancy outcomes, to develop interventions to improve the health of mothers and young children. We have established population-based periconceptional, pregnancy, and pediatric cohorts in Southern India, which informs the development of randomized clinical trials and evidence-based interventions to improve maternal and child nutrition.
We are conducting randomized trials, cohort studies, and population-based surveillance programs, with funding from the National Institutes of Health, the Centers for Disease Control and Prevention, the United States Department of Agriculture, and the U.S. Agency for International Development. Examples of current projects include:
A Randomized Trial of Quadruple Fortified Salt for Anemia and Birth Defects Prevention in Southern India, Centers for Disease Control and Prevention
Impact of Multiple Micronutrient-Fortified Salt on Gut Microbiome in Women of Reproductive Age, United States Department of Agriculture
Periconceptional Surveillance for Prevention of Anemia and Birth Defects in India, Centers for Disease Control and Prevention
Training in Maternal and Child Nutrition (MPI), National Institutes of Health
Determination of Iron and Inflammation Biomarkers in Saliva, National Institutes of Health
Nutritional Quality of Breast Milk after 6 Months Postpartum in India, National Institutes of Health
The role of vitamin B12 in the etiology of maternal and child health outcomes
We are examining the role of vitamin B12 in the etiology of anemia and adverse pregnancy outcomes in randomized trials, cohort studies, and surveillance programs, as part of our maternal and child nutrition research program in Southern India. We established a population-based periconceptional surveillance program in Southern India (NCT04048330), funded by the U.S. Centers for Disease Control and Prevention. We recently completed a pre-intervention biomarker survey among 1,192 women, highlighting a high burden of vitamin B12 deficiency and RBC folate insufficiency in this population for the first time - and identified vitamin B12 as a key modifier of folate biomarkers and risk of neural tube defects. Findings from this research was awarded Best Short Talk Award at the FASEB Folic Acid, Vitamin B12, and One-Carbon Metabolism Conference in 2020 and informed a session devoted to this topic in 2022. Our CDC and NIH-funded research program established and supports a regional reference laboratory for the WHO-recommended method for folate assessment, and World Health Organization-SEARO site for newborn and birth defects surveillance. Findings from the biomarker survey directly informed the development of a randomized trial of quadruple-fortified salt (NCT03853304) we are conducting in 1,000 households in Southern India.
Population-based surveillance of biomarkers of iron status and inflammation
We are examining the role of iron, vitamin B12, and folate in the etiology of anemia in randomized clinical trials, cohort studies, and population-based surveillance programs in Southern India. In a NIH-funded effort, we evaluated the roles of iron, vitamin B12, and folate, and inflammation in the etiology of anemia (R03EB023190). We recently completed a biomarker survey of vitamin B12, folate, and iron status in women of reproductive age in Southern India, funded by the CDC (6U19DD001218); findings demonstrated a high burden of iron deficiency in this population. We are extending this work in an NIH grant (1R21HD103974, PI Mehta) to evaluate how iron and inflammatory biomarkers can be evaluated in alternate matrices such as saliva, critical for evaluation of biomarkers in vulnerable populations including pregnant women and young children. I also co-led a team with Dr. Mehta that was awarded a National Institutes of Health $100K Technology Accelerator Challenge Prize for related work.
Interventions to improve maternal and child health
We have conducted several randomized trials in high-risk obstetric and pediatric populations in resource-limited settings, using micronutrient supplementation, fortification, and biofortification approaches. We published the first randomized trial of vitamin B12 supplementation in pregnant women, and the first randomized trials of biofortified pearl millet and biofortified beans in school-aged children. We completed two randomized efficacy trials of biofortified crops in mothers and young children, including a randomized trial of the effects of biofortified pearl millet on iron biomarkers, growth, and immune function in children (NCT02648893); and a randomized trial of multiple biofortified crops intervention on iron status in lactating women and their children (NCT02648893). We are now conducting the first randomized trial of quadruple-fortified salt (iron, iodine, vitamin B12, folic acid) for anemia and birth defects prevention (NCT03853304), funded by the CDC. Findings will establish the independent effects of vitamin B12 and folic acid on risk-predicting micronutrient biomarkers and inform the development of fortification guidelines for anemia and birth defects prevention.
The role of nutrition in the context of inflammation and infection
We have examined the intersection of micronutrients, inflammation, and infectious diseases, as part of randomized trials, cohort studies, and population-based surveillance programs, including HIV, tuberculosis, malaria, and dengue virus at our research field site in Southern India. Findings highlighted the key role of iron and vitamin B12 status as modifiable risk factors for HIV disease progression and severity. In collaboration with Dr. Mehta, we co-edited a book on HIV and nutrition, and published the first systematic review on metabolic complications in the context of HIV. We recently conducted the most comprehensive investigations to date of micronutrients, inflammation, and disease progression in patients with tuberculosis disease; burden of anemia, vitamin B12 deficiency and other key micronutrient deficiencies and their impact on obstetric and infant outcomes, among HIV-infected pregnant women initiating combination antiretroviral therapy; and on the role of micronutrients and immunological parameters in patients presenting with dengue virus infection. Findings from our recent research has informed the development of WHO emergency guidelines for infant feeding in the context of infections such as Zika virus and SARS-CoV-2.
Synthesis and translation of evidence to inform global guidelines and public health practice
A critical component of my research program is the synthesis and translation of evidence to inform public health practice. In my roles as Associate Director of the World Health Organization Collaborating Centre for Nutrition Research for Health and Deputy Director of the affiliate Cochrane Center for Nutrition at Cornell University, our team works with colleagues at WHO and CDC to synthesize evidence to inform international guidelines for nutrition and maternal and child health. We conducted the first meta-analysis and systematic review of the efficacy of iron biofortification interventions on iron status and functional outcomes. We also conducted the first systematic reviews to date on vitamin B12 and neural tube defects, vitamin B12 and child cognition, and vitamin B12 and the gut microbiome. We are leading Cochrane systematic reviews on Vitamin B12 supplementation in pregnancy for maternal and child health outcomes, and Vitamin B12 supplementation for growth, development, and cognition in children, in partnership with colleagues at the Centers for Disease Control and Prevention. Together, this evidence will help inform the development of guidelines for biomarker assessment and interventions to improve maternal and child health.