Vitamin A deficiency in infants: Effects of postnatal maternal vitamin A supplementation on the growth and vitamin A status

Background: The nutritional status of vitamin A in lactating mothers and infants is still not optimistic. Due to the dietary habits and dietary restrictions of postpartum customs in China, vitamin A supplementation has been advocated as a potential strategy to improve vitamin A status of lactating mothers with inadequate dietary vitamin A intake. Existing clinical trials are limited to single or double high-dose maternal administrations. However, in China, vitamin A supplements are readily available in the form of daily oral low-dose supplements, and the effect of these is unknown. This study aimed to evaluate the effects of daily oral low-dose vitamin A supplementation on the retinol levels in the serum and breast milk of lactating mothers and the health status of infants in China. Methods: Lactating mothers who met the inclusion criteria and planned to continue exclusive breastfeeding were randomly assigned to receive either daily oral vitamin A and D drops (one soft capsule of 1800 IU vitamin A and 600 IU vitamin D2), or a matching placebo for 2 months. Before and after the intervention, dietary intake was investigated by instant photography, and the retinol concentration in maternal serum and breast milk was determined by ultra-high performance liquid chromatography-tandem mass spectrometry. During the trial, the health status of infants was diagnosed by a paediatrician or reported by lactating mothers. A total of 245 participants completed the study, with 117 in the supplementation group and 128 in the control group. Results: After the 2-month intervention, maternal serum retinol concentrations increased in the supplementation group with no change in the control group. Although breast milk retinol concentrations decreased significantly in both groups, the decrease in the supplementation group was significantly lower than that in the control group. However, maternal vitamin A supplementation was not associated with a lower risk of infant febrile illness, respiratory tract infection, diarrhoea, and eczema. Conclusions: Daily oral low-dose vitamin A supplementation is helpful in improving maternal vitamin A status, despite having no effect on infant health status through breast milk.

Download Full-text

Early neonatal vitamin A supplementation and infant mortality: an individual participant data meta-analysis of randomised controlled trials

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-315242 ◽

2018 ◽

Vol 104 (3) ◽

pp. 217-226 ◽

Cited By ~ 8

Author(s):

Keyword(s):

Infant Mortality ◽

Vitamin A ◽

Maternal Education ◽

Vitamin A Deficiency ◽

Population Characteristics ◽

Infant Survival ◽

Vitamin A Supplementation ◽

Maternal Vitamin ◽

Early Infant ◽

The Impact

BackgroundBiannual vitamin A supplementation is a well-established survival tool for preschool children 6 months and older in vitamin A deficient populations but this schedule misses the opportunity to intervene on most young infant deaths. Randomised trials of neonatal vitamin A supplementation (NVAS) in the first few days of life to assess its impact on under 6-month mortality in low/middle-income countries have had varying results.MethodsInvestigators of 11 published randomised placebo-controlled NVAS trials (n=163 567 children) reanalysed their data according to an agreed plan and pooled the primary outcomes of mortality from supplementation through 6 and 12 months of age using random effects models and meta-regression. One investigator withdrew but allowed use of the data.FindingsOverall there was no effect of NVAS on infant survival through 6 (risk ratio (RR) 0.97; 95% CI 0.89 to 1.06) or 12 months of age (RR 1.00; 95% CI 0.93 to 1.08) but results varied by study population characteristics.NVAS significantly reduced 6-month mortality among the trials conducted in Southern Asia (RR 0.87; 95% CI 0.77 to 0.98), in contexts with moderate or severe vitamin A deficiency (defined as 10% or higher proportion of women with serum retinol <0.7 µmol/L or 5% or more women with night blindness) (RR 0.87; 95% CI 0.80 to 0.94), early infant mortality was 30 or more per 1000 live births (RR 0.91; 95% CI 0.85 to 0.98), 75% or more of infant mortality occurred in the first 6 months of life (RR 0.92; 95% CI 0.84 to 1.01), or where >32% mothers had no schooling (RR 0.88; 95% CI 0.80 to 0.96). NVAS did not reduce mortality in the first 6 months of life in trials conducted in Africa, in contexts characterised by a low prevalence of vitamin A deficiency, lower rates of infant mortality and where maternal education was more prevalent. There was a suggestion of increased infant mortality in trials conducted in Africa (RR 1.07; 95% CI 1.00 to 1.15).Individual-level characteristics such as sex, birth weight, gestational age and size, age at dosing, parity, time of breast feeding initiation, maternal education and maternal vitamin A supplementation did not modify the impact of NVAS.ConclusionNVAS reduced infant mortality in South Asia, in contexts where the prevalence of maternal vitamin A deficiency is moderate to severe and early infant mortality is high; but it had no beneficial effect on infant survival in Africa, in contexts where the prevalence of maternal vitamin A deficiency is lower, early infant mortality is low.

Download Full-text

The effect of retinyl palmitate added to iron-fortified maize porridge on erythrocyte incorporation of iron in African children with vitamin A deficiency

British Journal Of Nutrition ◽

10.1079/bjn2003914 ◽

2003 ◽

Vol 90 (2) ◽

pp. 337-343 ◽

Cited By ~ 15

Author(s):

Lena Davidsson ◽

Pierre Adou ◽

Christophe Zeder ◽

Thomas Walczyk ◽

Richard Hurrell

Keyword(s):

Single Dose ◽

Vitamin A ◽

Test Meal ◽

Vitamin A Deficiency ◽

Geometric Mean ◽

Retinyl Palmitate ◽

Dietary Vitamin ◽

Vitamin A Supplementation ◽

Vitamin A Status ◽

Before And After

Retinyl palmitate added to Fe-fortified maize bread has been reported to enhance Fe absorption in adult Venezuelan subjects but not in Western Europeans. It is not known to what extent these results were influenced by differences in vitamin A status of the study subjects. The objective of the present study was to evaluate the influence of retinyl palmitate added to Fe-fortified maize porridge on erythrocyte incorporation of Fe in children with vitamin A deficiency, before and after vitamin A supplementation. Erythrocyte incorporation of Fe-stable isotopes was measured 14 d after intake of maize porridge (2·0 mg Fe added as ferrous sulfate) with and without added retinyl palmitate (3·5 μmol; 3300 IU). The study was repeated 3 weeks after vitamin A supplementation (intake of a single dose of 210 μmol retinyl palmitate; ‘vitamin A capsule’). Vitamin A status was evaluated by the modified relative dose–response (MRDR) technique. Retinyl palmitate added to the test meal reduced the geometric mean erythrocyte incorporation of Fe at baseline from 4·0 to 2·6 % (P=0·008, n 13; paired t test). At 3 weeks after vitamin A supplementation, geometric mean erythrocyte incorporation was 1·9 and 2·3 % respectively from the test meal with and without added retinyl palmitate (P=0·283). Mean dehydroretinol:retinol molar ratios were 0·156 and 0·125 before and after intake of the single dose of 210 μmol retinyl palmitate; ‘vitamin A capsule’ (P=0·15). In conclusion, retinyl palmitate added to the labelled test meals significantly decreased erythrocyte incorporation of Fe in children with vitamin A deficiency at baseline but had no statistically significant effect 3 weeks after vitamin A supplementation. The difference in response to retinyl palmitate added to Fe-fortified maize porridge on erythrocyte incorporation of Fe before and after intake of the vitamin A capsule indicates, indirectly, changes in vitamin A status not measurable by the MRDR technique. The lack of conclusive data on the effect of retinyl palmitate on Fe absorption indicates the complexity of the interactions between vitamin A status, dietary vitamin A and Fe metabolism.

Download Full-text

The Vitamin A Status of Zambian Children in a Community of Vitamin A Supplementation and Sugar Fortification Strategies as measured by the Modified Relative Dose Response (MRDR) Test

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831.79.1.40 ◽

2009 ◽

Vol 79 (1) ◽

pp. 40-47 ◽

Cited By ~ 13

Author(s):

Emmanuel M. Kafwembe ◽

James Chipipa ◽

Eric Njunju ◽

Roma Chilengi

Keyword(s):

Vitamin A ◽

Dose Response ◽

Vitamin A Deficiency ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Vitamin A Supplementation ◽

Vitamin A Status ◽

The Status ◽

Modified Relative Dose Response

The main objective of the study was to determine the vitamin A status of Zambian children less than five years of age in a community where strategies of vitamin A supplementation and consumption of vitamin A fortified sugar have been introduced. In a cross-sectional study, a total of 537 children were enrolled. Their vitamin A status was measured using the modified relative dose response (MRDR) test. Their vitamin A status was compared to the status measured using a similar method in 1996, before vitamin A supplementation through capsule distribution and fortification of sugar was implemented as strategies to reduce vitamin A deficiency in the country. Results showed that the vitamin A status of children improved markedly as a result of these strategies.

Download Full-text

Research Recommendations for Applying Vitamin A-Labelled Isotope Dilution Techniques to Improve Human Vitamin A Nutrition

International Journal for Vitamin and Nutrition Research ◽

10.1024/0300-9831/a000185 ◽

2014 ◽

Vol 84 (Supplement 1) ◽

pp. 52-59 ◽

Cited By ~ 5

Author(s):

Sherry A. Tanumihardjo ◽

Anura V. Kurpad ◽

Janet R. Hunt

Keyword(s):

Public Health ◽

Vitamin A ◽

Vitamin A Deficiency ◽

Human Subjects ◽

The Body ◽

Pool Size ◽

Serum Retinol ◽

Vitamin A Status ◽

Status Assessment ◽

Total Body

The current use of serum retinol concentrations as a measurement of subclinical vitamin A deficiency is unsatisfactory for many reasons. The best technique available for vitamin A status assessment in humans is the measurement of total body pool size. Pool size is measured by the administration of retinol labelled with stable isotopes of carbon or hydrogen that are safe for human subjects, with subsequent measurement of the dilution of the labelled retinol within the body pool. However, the isotope techniques are time-consuming, technically challenging, and relatively expensive. There is also a need to assess different types of tracers and doses, and to establish clear guidelines for the use and interpretation of this method in different populations. Field-friendly improvements are desirable to encourage the application of this technique in developing countries where the need is greatest for monitoring the risk of vitamin A deficiency, the effectiveness of public health interventions, and the potential of hypervitaminosis due to combined supplement and fortification programs. These techniques should be applied to validate other less technical methods of assessing vitamin A deficiency. Another area of public health relevance for this technique is to understand the bioconversion of β-carotene to vitamin A, and its relation to existing vitamin A status, for future dietary diversification programs.

Download Full-text

The effects of maternal and infant vitamin A supplementation on vitamin A status: a randomised trial in Kenya

British Journal Of Nutrition ◽

10.1017/s0007114507705019 ◽

2007 ◽

Vol 98 (2) ◽

pp. 422-430 ◽

Cited By ~ 25

Author(s):

R. A. Ayah ◽

D. L. Mwaniki ◽

P. Magnussen ◽

A. E. Tedstone ◽

T. Marshall ◽

...

Keyword(s):

Vitamin A ◽

Controlled Trial ◽

Randomised Trial ◽

Maternal Serum ◽

High Dose ◽

Serum Retinol ◽

Double Blind ◽

Vitamin A Supplementation ◽

Factors Affecting ◽

Vitamin A Status

Postpartum vitamin A supplementation of mothers and infants is recommended, but the efficacy has been questioned. In this double-blind, placebo-controlled trial, Kenyan mother–infant pairs were randomised to maternal vitamin A (400 000 IU) or placebo < 24 h postpartum, and infant vitamin A (100 000 IU) or placebo at 14 weeks. Milk retinol was determined at weeks 4, 14 and 26, and maternal and infant serum retinol at weeks 14 and 26. Infant retinol stores were assessed at week 26, using a modified relative dose response (MRDR) test. Among 564 women, serum retinol at 36 weeks gestation was 0·81 (sd 0·21) μmol/l, and 33·3 % were < 0·7 μmol/l. Maternal serum retinol was not different between groups, but milk retinol was higher in the vitamin A group: (0·67 v. 0·60 μmol/l; 0·52 v. 0·44 μmol/l; 0·50 v. 0·44 μmol/l at 4, 14 and 26 weeks, respectively). When expressed per gram fat, milk retinol was higher in the vitamin A group only at 4 weeks. Infant serum retinol was not different between groups. However, although most infants had deficient vitamin A stores (MRDR>0·06 %) at 26 weeks, vitamin A to infants, but not mothers, resulted in a lower proportion of infants with deficient vitamin A stores (69 v. 78 %). High-dose postpartum vitamin A supplementation failed to increase serum retinol and infant stores, despite modest effects on milk retinol. Infant supplementation, however, increased stores. There is a need for a better understanding of factors affecting absorption and metabolism of vitamin A.

Download Full-text

Effect of maternal vitamin A supplementation on retinol concentration in colostrum

Jornal de Pediatria ◽

10.1016/j.jped.2014.05.004 ◽

2015 ◽

Vol 91 (1) ◽

pp. 81-86 ◽

Cited By ~ 8

Author(s):

Evellyn C. Grilo ◽

Mayara S.R. Lima ◽

Lahyana R.F. Cunha ◽

Cristiane S.S. Gurgel ◽

Heleni A. Clemente ◽

...

Keyword(s):

Vitamin A ◽

Vitamin A Supplementation ◽

Maternal Vitamin ◽

Retinol Concentration

Download Full-text

Vitamin A Supplementation and Measles

Pediatrics in Review ◽

10.1542/pir.16.9.358 ◽

1995 ◽

Vol 16 (9) ◽

pp. 358-359

Author(s):

Glenn J. Fennelly

Keyword(s):

Vitamin A ◽

Acute Phase ◽

Vitamin A Deficiency ◽

Serum Levels ◽

Morbidity And Mortality ◽

Serum Retinol ◽

Vitamin A Supplementation

Vitamin A deficiency resulting from inadequate intake or induced by infection is associated with increased morbidity and mortality. Measles, the major single infectious cause of mortality in children worldwide, is more severe in children who have preexisting vitamin A deficiency. Several recent studies suggest that: 1) measles is associated with depressed serum levels of vitamin A; 2) hyporetinemia, defined as a serum retinol of less than 0.7 µmol/L, is associated with increased mortality from measles, especially in children younger than 2 years of age; and 3) vitamin A will decrease the risk of complications and death when administered during the acute phase of illness (within 5 days of the onset of rash).

Download Full-text

Genotype Effects on β-Carotene Conversion to Vitamin A: Implications on Reducing Vitamin A Deficiency in the Philippines

Food and Nutrition Bulletin ◽

10.1177/03795721211060229 ◽

2021 ◽

pp. 037957212110602

Author(s):

Mark Pretzel P. Zumaraga ◽

Jose Maria Reynaldo Apollo Arquiza ◽

Mae Anne Concepcion ◽

Leah Perlas ◽

Ma. Neda Alcudia-Catalma ◽

...

Keyword(s):

Vitamin A ◽

Children And Adolescents ◽

Vitamin A Deficiency ◽

The Philippines ◽

Fisher Exact Test ◽

National Capital Region ◽

Nutrition Survey ◽

Vitamin A Status ◽

Genotype Frequencies

Background: The study aimed to identify two beta-carotene 15,15′-monooxygenase (BCMO1) mutations, namely R267S and A379V, and determine their association with vitamin A status among Filipinos 6 to 19 years old respondents of the 2013 Philippine National Nutrition Survey living in the National Capital Region. Materials and Methods: This study followed cross-sectional design. Whole blood specimen was collected in the morning and was used as source of genomic DNA and serum for retinol concentration determination. Fisher exact test was performed to determine whether genotype frequencies were associated to retinol concentrations/vitamin A deficiency status. A level of P < .05 was identified as significant. Results: A total of 693 Filipino children and adolescents were included. Of the 693, there were at least 7.6% who bears the combined mutations for R267S + A379V. Association analysis showed that an inverse relationship exists between the A379V TT variant and vitamin A status. Although the exact role of these identified polymorphisms on retinol/carotenoid metabolism need to be confirmed in dedicated functional studies. Conclusion: This study has identified for the first time the presence of 2 nonsynonymous genetic variants/mutations in the coding region of BCMO1 gene. Interestingly, one of these two variants, the A379V T, was found to be associated with vitamin A status. It is, therefore, warranted to investigate the role of BCMO1 variants for the success of supplementation programs and fortification efforts among vulnerable populations in this region. Genetic variability should be considered for future provitamin A supplementation recommendations among children and adolescents in the Philippines.

Download Full-text

Congenital Malformations Induced in Rats by Maternal Vitamin a Deficiency

Journal of Nutrition ◽

10.1093/jn/35.1.npa ◽

1948 ◽

Vol 35 (1) ◽

Cited By ~ 1

Keyword(s):

Vitamin A ◽

Congenital Malformations ◽

Vitamin A Deficiency ◽

Maternal Vitamin

Download Full-text