scholarly journals Five-year follow-up of a food-based vitamin A intervention in Tanzania

2000 ◽  
Vol 3 (4) ◽  
pp. 425-431 ◽  
Author(s):  
Diana Kidala ◽  
Ted Greiner ◽  
Mehari Gebre-Medhin
Keyword(s):  
Vitamin A ◽  
Nutrition Education ◽  
Control Area ◽  
Long Term Effects ◽  
Serum Retinol ◽  
Programme Implementation ◽  
Serum Samples ◽  
Dietary Practices ◽  
Experimental Area ◽  
Quasi Experimental

AbstractObjectiveTo evaluate the long-term effects of a horticultural and nutrition education intervention in rural Tanzania.DesignA quasi-experimental post-test design was used.SettingThe research was carried out in 10 villages in Singida region, Tanzania.SubjectsMothers and their children aged 6–71 months (n = 236) from an experimental (Ilongero) and control (Ihanja) area were interviewed regarding knowledge and practices related to vitamin A nutrition. Intake of vitamin A-rich foods by the children during the 7 days prior to the interview was recorded. Stools were examined for helminths and serum samples were analysed for retinol and C-reactive protein (CRP) (n = 146) for the children aged 12–71 months.ResultsKnowledge and practices were more favourable to vitamin A intake in the experimental area than in the control area, and an increased frequency of intake of green leaves was associated with higher serum retinol values. The experimental area had lower mean serum retinol levels (13.7 μg dl−1, n = 75) than the control area (19.3 μg dl−1, n = 71). One likely confounder was the higher helminth infestation in the experimental area (n = 75, 79%) than in the control area (n = 71, 49%) (P > 0.001). Children with helminths (n = 94) had a lower mean serum retinol level than those without (n = 52) (12.3 ± 5 vs. 24 ± 10 μg dl−1; P = 0.001).ConclusionsFood-based vitamin A programmes can make sustainable improvements in knowledge and dietary practices but these may not necessarily be reflected in increases in serum retinol. Programme implementation and evaluation should take confounders into consideration as, in this case, helminth infestation.

scholarly journals A new approach to the assessment of marginal vitamin A deficiency in children in suburban Guwahati, India: hydrolysis of retinoyl glucuronide to retinoic acid

2008 ◽  
Vol 101 (6) ◽  
pp. 794-797 ◽  
Author(s):  
Pulin C. Sarma ◽  
Bhabesh C. Goswami ◽  
Krishna Gogoi ◽  
Harsha Bhattacharjee ◽  
Arun B. Barua
Keyword(s):  
Retinoic Acid ◽  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Serum Retinol ◽  
Serum Samples ◽  
Group I ◽  
High Prevalence ◽  
Hydrolysis Of ◽  
Β Carotene

The objective of the present study was to determine marginal vitamin A deficiency (VAD) by testing the hydrolysis of retinoyl glucuronide (RAG) to retinoic acid (RA) in children. Previous studies in rats showed that hydrolysis occurred when rats were vitamin A deficient. Children (n 61) aged 3–18 years, were divided into two groups, I and II. Blood was collected from the children in Group I (n 19) who were not dosed with RAG. Children in Group II (n 42) were administered all-trans retinoyl glucuronide (RAG) orally, and blood was collected 4 h after the dose. All serum samples were analysed for retinoids and carotenoids. RA was detected in serum only when serum retinol was < 0·85 μmol/l. Thus, hydrolysis of RAG to RA occurred in children with VAD or marginal VAD. Serum retinol was < 0·35 μmol/l in twenty-one children, 0·35–0·7 μmol/l in twenty-three children, 0·7–0·9 μmol/l in eleven children and >1 μmol/l in six children. Mean serum retinol in sixty-one children was 0·522 (sd 0·315) μmol/l. Mean β-carotene (0·016 (sd 0·015) μmol/l) was far below normal compared to the level of lutein (0·176 (sd 0·10) μmol/l) in sixty-one children. A low β-carotene level might be due to a low intake of carotene but high demand for vitamin A. The RAG hydrolysis test may prove to be a useful approach for the determination of marginal VAD with no clinical or subclinical signs of VAD. High prevalence of VAD amongst certain communities in Assam cannot be ruled out.

scholarly journals Impact of promotion of mango and liver as sources of vitamin A for young children: a pilot study in Burkina Faso

2006 ◽  
Vol 9 (6) ◽  
pp. 808-813 ◽  
Author(s):  
CP Nana ◽  
ID Brouwer ◽  
NM Zagré ◽  
FJ Kok ◽  
AS Traoré
Keyword(s):  
Pilot Study ◽  
Vitamin A ◽  
Burkina Faso ◽  
Financial Support ◽  
Control Area ◽  
Serum Retinol ◽  
Treatment Groups ◽  
Parallel Design ◽  
Serum Retinol Concentration ◽  
Retinol Concentration

AbstractObjectiveTo assess the effectiveness of a behaviour change approach, with or without financial support, in improving vitamin A (VA) intake and serum retinol concentration through mango and liver consumption by children.DesignA parallel design (no control area) was used to assess changes in VA intake and serum retinol over a 15-week period.Setting and subjectsA pilot study was implemented in the Department of Kokologho, a rural area in central west Burkina Faso. One hundred and fifty children aged 2–3 years were randomly selected and assigned to two treatment groups: PA$$ (promotional activities and financial support) and PA (promotional activities).ResultsThe intervention significantly increased (P<0.001) total VA intake by 56% in PA$$ and by 50% in PA. VA intake from liver increased significantly (P<0.001) from 12.7±23.5 to 155.3±56.3 μg retinol activity equivalents (RAE) in PA$$ and from 21.6±29.7 to 135.3±44.9 μg RAE in PA. Changes in VA intake from liver were significantly higher (P=0.004) in PA$$ compared with PA. Mean serum retinol concentration increased significantly by 26% (P<0.001) in PA$$ and 30% (P<0.001) in PA. Changes in serum retinol concentration (0.13 μmol l−1 in PA$$ vs. 0.17 μmol l−1 and in PA) did not differ significantly (P=0.455) between groups over the intervention.ConclusionPromotional activities on mango and liver intake effectively increased VA intake and serum retinol concentrations. Although an additional beneficial effect of financial support on liver intake was observed, this did not translate into a further increase in serum retinol concentration.

scholarly journals Vitamin A deficiency in Bangladesh: a review and recommendations for improvement

1999 ◽  
Vol 2 (1) ◽  
pp. 1-14 ◽  
Author(s):  
Faruk Ahmed
Keyword(s):  
Vitamin A ◽  
Nutrition Education ◽  
Night Blindness ◽  
Vitamin A Deficiency ◽  
School Age Children ◽  
Serum Retinol ◽  
Population Groups ◽  
Vitamin A Status ◽  
Subclinical Vitamin

AbstractObjective:This article provides a comprehensive review of the change in vitamin A status and the extent of vitamin A deficiency among different population groups in Bangladesh up to the present time. The result of experience with different strategies and interventions designed to improve vitamin A status are then reviewed, leading to a discussion of key options for action, as well as important areas for research and evaluation.Design and setting:All the available data have been examined in detail, including data from nationally representative samples and nationwide surveys, as well as small studies in different population groups. Reports on the effectiveness of different intervention programmes have been used.Results:Over the past three decades a number of studies, which include national nutrition surveys, have been carried out to investigate the prevalence of vitamin A deficiency among different population groups in Bangladesh, and they have demonstrated a significant public health problem. Studies have shown that the prevalence of severe deficiency, based on the prevalence of night blindness in preschool children, decreased from 3.6% in 1982–83 to 1.78% in 1989 and 0.6% in 1996. However, there is still a high prevalence of subclinical vitamin A deficiency, based on the biochemical assessment of serum retinol levels in preschool children, estimated mainly from hospital-based groups. Night blindness and Bitot's spot are also found to exist among school-age children and adolescents. Recent reports indicate that night blindness among rural mothers is as high as 1.4%. Only a limited number of studies, with small sample sizes, are available where serum retinol has been reported for school-age children, adolescents and pregnant women. Nevertheless, these studies confirm the presence of low levels of serum retinol and hence, the existence of subclinical vitamin A deficiency. Furthermore, the dietary intake of vitamin A in each population group has been found to be less than the Recommended Daily Allowance (RDA), indicating a significant risk of deficient intakes of vitamin A.To address the problem of vitamin A deficiency, the government of Bangladesh started the Nutritional Blindness Programme in 1973. The main activities of the programme include vitamin A capsule (VAC) supplementation to children of 6 months to 6 years old, nutrition education to increase the production and consumption of vitamin A rich foods, and training of primary health-care workers on the clinical diagnosis and treatment of vitamin A deficiency, VAC distribution and nutrition education. Since 1988, as a long-term strategy, Helen Keller International has been implementing community home gardening promotion projects. To date, the possibility that foods may be fortified with vitamin A, has not been explored as a possible approach in Bangladesh.Conclusion:Although short- to long-term prevention and control programmes are to some extent in place, to improve the situation of vitamin A deficiency, Bangladesh needs a more appropriate mix of interventions for the entire population. More operational research and evaluation are needed if a fully effective programme to alleviate the problem of vitamin A deficiency is to be developed. Finally, to achieve the goal of virtual elimination of vitamin A deficiency will require an integrated approach which brings together appropriate actions at every level, within and across the many sectors of society.

scholarly journals Metabolomics Identifies Serum Metabolites Different in Zambian Women with Adequate versus Deficient Total Liver Vitamin A Reserves Despite Adequate Serum Retinol Levels

2021 ◽  
Vol 5 (Supplement_2) ◽  
pp. 73-73
Author(s):  
Catherine Johnson ◽  
Sophia Brown ◽  
Chandler Phelps ◽  
Chisela Kaliwile ◽  
Jesse Sheftel ◽  
...  
Keyword(s):  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Future Research ◽  
Serum Retinol ◽  
Serum Samples ◽  
Metabolomics Data ◽  
Total Liver ◽  
Funding Sources ◽  
University Of Wisconsin ◽  
Deficient Group

Abstract Objectives Vitamin A deficiency (VAD) has remained a leading cause of morbidity and mortality throughout the world for decades, however there are still challenges defining VA status because the most common biomarker, serum retinol, is regulated homeostatically except in extreme deficiency and affected by inflammation; therefore, more accurate biomarkers to define VAD are needed. Furthermore, the effects of VAD on metabolism are still being uncovered. The objective was to investigate whether serum metabolomics profiles differed between Zambian women with adequate versus deficient VA status measured by the gold-standard biomarker total liver VA reserves (TLR) whose serum retinol concentrations did not differ. Methods Retinol isotope dilution (RID) was used to estimate TLR in Zambian women in the Rufunsa district; serum aliquots were selected for metabolomics based on adequate (TLR &gt; 0.1–1 μmol VA/g liver) or deficient (TLR &lt; 0.1 μmol/g) VA status (n = 10/group). Serum retinol levels were indicative of adequacy (&gt;0.7 μmol/L) and were not different between groups. Serum samples were analyzed by LC-MS using four metabolomics assays. Metabolomics data were covariate-adjusted for age and BMI. Results Ten metabolites were different between the adequate and deficient vitamin A groups (P &lt; 0.05). Metabolites lower in the deficient group included multiple phosphatidylcholines (PCs) and phosphatidylethanolamines (PEs), as well as lipoxygenase (LOX)-derived oxylipins (9-HODE and 17-HDoHE), choline, and anthranilic acid. One cholestryl ester was elevated in the deficient group. Conclusions The study revealed numerous metabolites altered by RID-measured VAD and adequacy despite similarly adequate serum retinol levels in both groups. Future research is required to investigate the mechanisms by which phospholipids such as PCs and PEs, as well as LOX-derived oxylipins, are altered by VA status and the potential use of these metabolites as biomarkers of VAD. Funding Sources University of Wisconsin-Madison Global Health Institute visiting scholar fellowship (CK and SAT).

scholarly journals Effects of Inflammation on Biomarkers of Vitamin A Status among a Cohort of Bolivian Infants

Nutrients ◽  
2018 ◽  
Vol 10 (9) ◽  
pp. 1240 ◽  
Author(s):  
Rachel Burke ◽  
Ralph Whitehead ◽  
Janet Figueroa ◽  
Denis Whelan ◽  
Anna Aceituno ◽  
...  
Keyword(s):  
Infant Mortality ◽  
Linear Regression ◽  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Retinol Binding Protein ◽  
Molar Ratio ◽  
Serum Retinol ◽  
Serum Samples ◽  
Mortality And Morbidity ◽  
Vitamin A Status

Globally, vitamin A deficiency (VAD) affects nearly 200 million children with negative health consequences. VAD can be measured by a retinol-binding protein (RBP) and serum retinol concentrations. Their concentrations are not always present in a 1:1 molar ratio and are affected by inflammation. This study sought to quantify VAD and its impact on infant mortality and infectious morbidity during the first 18 months of life in a cohort of mother-infant dyads in El Alto, Bolivia, while accounting for the previously mentioned measurement issues. Healthy mother-infant dyads (n = 461) were enrolled from two hospitals and followed for 12 to 18 months. Three serum samples were collected (at one to two, six to eight, and 12 to 18 months of infant age) and analyzed for RBP, and a random 10% subsample was analyzed for retinol. Linear regression of RBP on retinol was used to generate RBP cut-offs equivalent to retinol <0.7 µmol/L. All measures of RBP and retinol were adjusted for inflammation, which was measured by a C-reactive protein and alpha (1)-acid glycoprotein serum concentrations using linear regression. Infant mortality and morbidity rates were calculated and compared by early VAD status at two months of age. Retinol and RBP were weakly affected by inflammation. This association varied with infant age. Estimated VAD (RBP < 0.7 µmol/L) decreased from 71.0% to 14.8% to 7.7% at two, six to eight, and 12 to 18 months of age. VAD was almost nonexistent in mothers. Early VAD was not significantly associated with infant mortality or morbidity rates. This study confirmed a relationship between inflammation and vitamin A biomarkers for some subsets of the population and suggested that the vitamin A status in early infancy improves with age and may not have significantly affected morbidity in this population of healthy infants.

scholarly journals Red palm oil as a source of vitamin A for mothers and children: impact of a pilot project in Burkina Faso

2003 ◽  
Vol 6 (8) ◽  
pp. 733-742 ◽  
Author(s):  
NM Zagré ◽  
F Delpeuch ◽  
P Traissac ◽  
H Delisle
Keyword(s):  
Vitamin A ◽  
Burkina Faso ◽  
Palm Oil ◽  
Pilot Project ◽  
Control Area ◽  
Serum Retinol ◽  
Post Intervention ◽  
Diversification Strategy ◽  
Red Palm Oil ◽  
Mothers And Children

AbstractObjective:To demonstrate the effectiveness of the commercial introduction of red palm oil (RPO) as a source of vitamin A (VA) for mothers and children in a non-consuming area, as a dietary diversification strategy.Design:A pre–post intervention design (no control area) was used to assess changes in VA intake and status over a 24-month pilot project.Setting and subjects:The pilot project involved RPO promotion in 10 villages and an urban area in east-central Burkina Faso, targeting approximately 10?000 women and children aged < 5 years. A random sample of 210 mother–child (12–36-months-old) pairs was selected in seven out of the 11 pilot sites for the evaluation.Results:After 24 months, RPO was reportedly consumed by nearly 45% of mothers and children in the previous week. VA intake increased from 235 ± 23 μg retinol activity equivalents (RAE) to 655 ± 144 μg RAE in mothers (41 to 120% of safe intake level), and from 164 ± 14 μg RAE to 514 ± 77 μg RAE in children (36 to 97%). Rates of serum retinol < 0.70 μmoll−1 decreased from 61.8 ± 8.0% to 28.2 ± 11.0% in mothers, and from 84.5 ± 6.4% to 66.9 ± 11.2% in children. Those with a lower initial concentration of serum retinol showed a higher serum retinol response adjusted for VA intake.Conclusions:Commercial distribution of RPO was effective in reducing VA deficiency in the pilot sites. While it is promising as part of a national strategy, additional public health and food-based measures are needed to control VA malnutrition, which remained high in the RPO project area

scholarly journals Nutritional status and dietary practices of 4–24-month-old children from a rural South African community

1999 ◽  
Vol 2 (2) ◽  
pp. 179-185 ◽  
Author(s):  
Mieke Faber ◽  
AJS Benadé
Keyword(s):  
Vitamin A ◽  
Nutritional Status ◽  
Nutrition Education ◽  
South African ◽  
Iron Status ◽  
Animal Origin ◽  
Growth Monitoring ◽  
Dietary Practices ◽  
Rural South ◽  
African Community

AbstractObjectivesTo assess the nutritional status and dietary practices of 4–24-month-old children (under-twos) in a rural South African community.DesignCross-sectional survey.SettingA low socioeconomic rural African community (Ndunakazi), approximately 60 km north-west of Durban, KwaZulu-Natal, South Africa.SubjectsChildren (n= 115), 4–24 months old who attended growth monitoring posts in the area.ResultsOf these under-twos, 37.3% had low vitamin A status (serum retinol < 20 μg dl−1), 65.2% were anaemic, 43.2% had serum ferritin levels < 10 μgl−1(an indicator of low iron stores) and 15.3% were stunted. Breastfeeding was initiated by 99% of mothers. At the time of the survey, 80% of infants in the 4–12-month-old category and 56.9% of children in the 12–24-month-old category were being breastfed. Solid foods were introduced at 3.6 ± 0.8 months. Food intake reflected a high intake of carbohydrate-rich foods, and irregular intakes of fruit and vegetables, especially those rich in vitamin A. Foods of animal origin were not consumed regularly. Of these under-twos, 15.9% experienced an episode of diarrhoea during 2 weeks prior to the survey.ConclusionThese under-twos had a poor vitamin A and iron status. Nutrition education, intervention programmes and feeding schemes should address micronutrient deficiencies, with the focus on the quality of the diet, rather than quantity.

A re-examination of the stability of retinol in blood and serum, and effects of a standardized meal.

1988 ◽  
Vol 34 (11) ◽  
pp. 2308-2310 ◽  
Author(s):  
M H Barreto-Lins ◽  
F A Campos ◽  
M C Azevedo ◽  
H Flores
Keyword(s):  
Vitamin A ◽  
Serum Retinol ◽  
Anaerobic Conditions ◽  
Serum Samples ◽  
Moderate Amount ◽  
Normal Volunteers ◽  
The Stability

Abstract We examined the stability of retinol in blood and serum samples, kept in the dark, under different handling procedures. Samples not protected from contact with air oxygen were highly unstable, even when kept at ice temperature. Samples collected under anaerobic conditions, with Vacutainer Tubes, or treated with nitrogen after collection to displace the air from the tubes were stable during the usual interval between collection and freezing or analysis in biochemical surveys. Ingestion of a moderate amount of vitamin. A significantly increased serum retinol concentrations in normal volunteers, showing the importance that survey samples be preprandial.

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

2014 ◽  
Vol 84 (Supplement 1) ◽  
pp. 52-59 ◽  
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.

scholarly journals Effect of collaborative quality improvement on stillbirths, neonatal mortality and newborn care practices in hospitals of Telangana and Andhra Pradesh, India: evidence from a quasi-experimental mixed-methods study

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Karen Zamboni ◽  
Samiksha Singh ◽  
Mukta Tyagi ◽  
Zelee Hill ◽  
Claudia Hanson ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Neonatal Mortality ◽  
Process Evaluation ◽  
Andhra Pradesh ◽  
Newborn Care ◽  
Mechanisms Of Change ◽  
Evidence Based ◽  
Programme Implementation ◽  
Quasi Experimental ◽  
Care Practices

Abstract Background Improving quality of care is a key priority to reduce neonatal mortality and stillbirths. The Safe Care, Saving Lives programme aimed to improve care in newborn care units and labour wards of 60 public and private hospitals in Telangana and Andhra Pradesh, India, using a collaborative quality improvement approach. Our external evaluation of this programme aimed to evaluate programme effects on implementation of maternal and newborn care practices, and impact on stillbirths, 7- and 28-day neonatal mortality rate in labour wards and neonatal care units. We also aimed to evaluate programme implementation and mechanisms of change. Methods We used a quasi-experimental plausibility design with a nested process evaluation. We evaluated effects on stillbirths, mortality and secondary outcomes relating to adherence to 20 evidence-based intrapartum and newborn care practices, comparing survey data from 29 hospitals receiving the intervention to 31 hospitals expected to receive the intervention later, using a difference-in-difference analysis. We analysed programme implementation data and conducted 42 semi-structured interviews in four case studies to describe implementation and address four theory-driven questions to explain the quantitative results. Results Only 7 of the 29 intervention hospitals were engaged in the intervention for its entire duration. There was no evidence of an effect of the intervention on stillbirths [DiD − 1.3 percentage points, 95% CI − 2.6–0.1], on neonatal mortality at age 7 days [DiD − 1.6, 95% CI − 9–6.2] or 28 days [DiD − 3.0, 95% CI − 12.9—6.9] or on adherence to target evidence-based intrapartum and newborn care practices. The process evaluation identified challenges in engaging leaders; challenges in developing capacity for quality improvement; and challenges in activating mechanisms of change at the unit level, rather than for a few individuals, and in sustaining these through the creation of new social norms. Conclusion Despite careful planning and substantial resources, the intervention was not feasible for implementation on a large scale. Greater focus is required on strategies to engage leadership. Quality improvement may need to be accompanied by clinical training. Further research is also needed on quality improvement using a health systems perspective.

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