Effects on Vitamin A Deficiency in Children of Periodic High-Dose Supplements and of Fortified Oil Promotion in a Deficient Area of the Philippines

2011 ◽  
Vol 81 (5) ◽  
pp. 295-305 ◽  
Author(s):  
John B. Mason ◽  
Maria A. Ramirez ◽  
Chona M. Fernandez ◽  
Regina Pedro ◽  
Tina Lloren ◽  
...  
Keyword(s):  
Vitamin A ◽  
Vitamin A Deficiency ◽  
The Philippines ◽  
High Dose ◽  
Serum Retinol ◽  
Monthly Dosing ◽  
Survey Estimates ◽  
Annual Distribution ◽  
Deficient Area ◽  
Sustained Increase

Regular semi-annual distribution of high-dose (200,000 IU) vitamin A capsules (VACs) to children 1 - 5 years of age (previously identified as underweight), in Leyte Province, the Philippines, was compared to providing extra VACs to give three-monthly dosing, and to vitamin A-fortified cooking oil (VAFO) promotion (with continued VACs every 6 months). Serum retinol (SR) was measured at baseline and after 12 or 18 months (for VAFO). No sustained increase in SR was determined from the three-month VAC dosing regimen, and the prevalence of vitamin A deficiency (VAD) as assessed by SR (< 20 mcg / dL) remained around 30 % (in line with national survey estimates over the previous 15 years). The major difference found was that 18 months of VAFO (of which 9 months had sustained promotion) was associated with reducing the prevalence of VAD to < 10 %. The effective fortification and lack of effect of semi-annual VAC results are in line with previous studies; testing with dosing of VAC every three months is a new intervention. The results imply that promotion of fortified oil would reduce VAD in these conditions; whether it can replace or needs to be added to semi-annual VAC dosing remains to be determined. A phased changeover to reliance on fortified commodities (including oil) with careful monitoring of VAD trends is indicated.

Vitamin A deficiency among children younger than 5 y in India: an analysis of national data sets to reflect on the need for vitamin A supplementation

2020 ◽  
Author(s):  
G Bhanuprakash Reddy ◽  
Raghu Pullakhandam ◽  
Santu Ghosh ◽  
Naveen K Boiroju ◽  
Shalini Tattari ◽  
...  
Keyword(s):  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Public Health Problem ◽  
Sample Survey ◽  
Dietary Vitamin ◽  
High Dose ◽  
Serum Retinol ◽  
Indian Children ◽  
Vitamin A Supplementation ◽  
National Prevalence

ABSTRACT Background Biochemical vitamin A deficiency (VAD) is believed to be a serious public health problem (low serum retinol prevalence &gt;20%) in Indian children, justifying universal high-dose vitamin A supplementation (VAS). Objective To evaluate in Indian children younger than 5 y the risk of biochemical VAD from the Comprehensive National Nutrition Survey, as well as dietary vitamin A inadequacy and excess over the tolerable upper limit of intake (TUL) from national and subnational surveys, factoring in fortification and VAS. Methods Child serum retinol data, corrected for inflammation, were examined to evaluate national- and state-level prevalence of VAD. Simultaneously, dietary intakes from the National Sample Survey Office and the National Nutrition Monitoring Bureau were examined for risk of dietary vitamin A deficiency against its average requirement (AR) derived for Indian children. Theoretical estimates of risk reduction with oil and milk vitamin A fortification were evaluated along with the risk of exceeding the TUL, as well as when combined with intake from VAS. Results The national prevalence of biochemical VAD measured in 9563 children was 15.7% (95% CI: 15.2%, 16.3%), and only 3 states had prevalence significantly &gt;20%. The AR of vitamin A was 198 and 191 µg/d for boys and girls; the risk of dietary inadequacy was ∼70%, which reduced to 25% with oil and milk fortification. Then, the risk of exceeding the TUL was 2% and 1% in 1- to 3-y-old and 4- to 5-y-old children, respectively, but when the VAS dose was added to this intake in a cumulative 6-mo framework, the risk of exceeding the TUL rose to 30% and 8%, respectively. Conclusion The national prevalence of VAD risk is below 20% in Indian children. Because there is risk of excess intake with food fortification and VAS, serious consideration should be given to a targeted approach in place of the universal VAS program in India.

Xerophthalmia due to vitamin A deficiency following Frey’s procedure for chronic calcific pancreatitis

2021 ◽  
Vol 14 (5) ◽  
pp. e242710
Author(s):  
Supriya Sharma ◽  
Somasheila I Murthy ◽  
Manjushree Bhate ◽  
Varsha Rathi
Keyword(s):  
Vitamin A ◽  
Replacement Therapy ◽  
Vitamin A Deficiency ◽  
High Dose ◽  
Serum Retinol ◽  
Rare Presentation ◽  
Exocrine Insufficiency ◽  
Enzyme Replacement ◽  
Chronic Calcific Pancreatitis ◽  
Calcific Pancreatitis

We report a rare presentation of xerophthalmia due to partial pancreatic exocrine insufficiency following Frey’s surgery (pancreatic resection) in a 12-year-old girl. The child had undergone this surgery for chronic calcific pancreatitis 3 years before and presented with ocular irritation and decreased vision of 3 months duration. Ocular examination showed severe conjunctival and corneal xerosis. Her serum retinol levels and 25-hydroxyvitamin D were tested and were extremely low. The condition rapidly reversed following high-dose replacement therapy with vitamin A and D. This case highlights the importance of continuous enzyme replacement therapy as well as dietary modification and nutritional supplement therapy and monitoring of ocular symptoms in post-pancreatic surgery.

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 South African preschool children habitually consuming sheep liver and exposed to vitamin A supplementation and fortification have hypervitaminotic A liver stores: a cohort study

2019 ◽  
Vol 110 (1) ◽  
pp. 91-101 ◽  
Author(s):  
Martha E van Stuijvenberg ◽  
Muhammad A Dhansay ◽  
Jana Nel ◽  
Devika Suri ◽  
Michael Grahn ◽  
...  
Keyword(s):  
South Africa ◽  
Preschool Children ◽  
Vitamin A ◽  
Total Serum ◽  
High Dose ◽  
Serum Retinol ◽  
Hypervitaminosis A ◽  
Total Liver ◽  
Before And After ◽  
Retinyl Esters

ABSTRACT Background In some regions, multiple vitamin A (VA) interventions occur in the same target groups, which may lead to excessive stores. Retinol isotope dilution (RID) is a more sensitive technique than serum retinol to measure VA status. Objective We evaluated VA status before and after a high-dose supplement in preschool children living in a region in South Africa with habitual liver consumption and exposed to VA supplementation and fortification. Methods After baseline blood samples, subjects (46.7 ± 8.4 mo; n = 94) were administered 1.0 μmol [14,15]-13C2-retinyl acetate to estimate total liver retinol reserves by RID with a follow-up 14-d blood sample. Liver intake was assessed with a frequency questionnaire. In line with current practice, a routine 200,000 IU VA capsule was administered after the RID test. RID was repeated 1 mo later. Serum retinyl esters were evaluated using ultra-performance liquid chromatography. Results At baseline, 63.6% of these children had hypervitaminosis A defined as total liver retinol reserves ≥1.0 μmol/g liver, which increased to 71.6% after supplementation (1.13 ± 0.43 to 1.29 ± 0.46 μmol/g; P < 0.001). Total serum VA as retinyl esters was elevated in 4.8% and 6.1% of children before and after supplementation. The odds of having hypervitaminosis A at baseline were higher in children consuming liver ≥1/mo (ratio 3.70 [95% CI: 1.08, 12.6]) and in children receiving 2 (4.28 [1.03, 17.9]) or 3 (6.45 [0.64, 65.41]) supplements in the past 12 mo. Total body stores decreased after the supplement in children in the highest quartile at baseline compared with children with lower stores, who showed an increase (P = 0.007). Conclusions In children, such as this cohort in South Africa, with adequate VA intake through diet, and overlapping VA fortification and supplementation, preschool VA capsule distribution should be re-evaluated. This trial was registered at https://clinicaltrials.gov/ct2/show/NCT02915731 as NCT02915731.

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

2007 ◽  
Vol 98 (2) ◽  
pp. 422-430 ◽  
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.

Vitamin A Supplementation and Measles

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).

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

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.

scholarly journals SEANUTS: the nutritional status and dietary intakes of 0.5–12-year-old Thai children

2013 ◽  
Vol 110 (S3) ◽  
pp. S36-S44 ◽  
Author(s):  
Nipa Rojroongwasinkul ◽  
Kallaya Kijboonchoo ◽  
Wanphen Wimonpeerapattana ◽  
Sasiumphai Purttiponthanee ◽  
Uruwan Yamborisut ◽  
...  
Keyword(s):  
Vitamin D ◽  
Vitamin A ◽  
Nutritional Status ◽  
Rural Areas ◽  
Urban Areas ◽  
Vitamin A Deficiency ◽  
Public Health Problem ◽  
Rural Children ◽  
Major Public Health Problem ◽  
Serum Retinol

In the present study, we investigated nutritional status and health-related factors in a multistage cluster sample of 3119 Thai urban and rural children aged 0·5–12·9 years. In a subsample, blood samples were collected for the measurement of Hb, transferrin receptor, vitamin A and vitamin D concentrations. The prevalence of stunting and underweight was higher in rural children than in urban children, whereas the wasting rate was similar in both rural and urban areas. Among children aged 3·0–5·9 years, the prevalence of overweight was significantly higher in urban areas than in rural areas and so was the obesity rate in children aged 6·0–12·9 years. Protein intakes of all age groups were relatively high in both the areas. Intakes of Ca, Fe, Zn and vitamin C were significantly higher in urban areas than in rural areas. The prevalence of anaemia in rural areas was twice as high as that in urban areas, particularly in infants and young children. However, the prevalence of Fe-deficiency anaemia was similar in both urban and rural areas. While the prevalence of vitamin A deficiency (by serum retinol cut-off < 0·7 μmol/l) seemed to be very low, vitamin A insufficiency (by serum retinol cut-off < 1·05 μmol/l) was more prevalent (29·4–31·7 %) in both the areas. The prevalence of vitamin D insufficiency ranged between 27·7 and 45·6 % among the children. The present study indicates that the double burden of malnutrition is still a major public health problem in Thailand. Further studies need to explore the associated risk factors for these nutrient deficiencies. Effective strategies and actions are needed to tackle the nutritional problems in Thai children.

scholarly journals Combatting Vitamin A deficiency

2017 ◽  
Vol 8 (2) ◽  
pp. 151 ◽  
Author(s):  
Ted H Greiner
Keyword(s):  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Economic Benefits ◽  
Point Of View ◽  
Preschool Age ◽  
High Dose ◽  
Sample Sizes ◽  
Sweet Potatoes ◽  
Target Groups ◽  
Wide Range

Food-based approaches to combat vitamin A deficiency (VAD) continue to be largely ignored by governments and donor agencies. This review deals with common misperceptions as well as constraints that may lay behind this reality. First, high-dose vitamin A capsules provided to preschool age children are no solution for VAD. Second, researchers may assume that it is not possible to standardize foods adequately to study their efficacy in controlled trials. This review summarizes the results of 57 such trials, providing an overview that may assist researchers in making decisions on target groups to study, types of food supplements to provide, quantities, supplementation periods, impacts that are realistic to expect, and sample sizes. Even more complex is to design efficacy trials or impact evaluations of interventions. Again, the paper reviews 40 such trials, providing summary information on approaches, target groups, sample sizes, periods of intervention, and impacts measured using a variety of indicators. There are a number of barriers or constraints that must be planned for and overcome if food-based approaches are to work. This paper reviews several of the most important ones, briefly touching on many of the most effective ways that have been found to overcome them. Food-based approaches can reach all members of the community, are safe for pregnant women, tend to be at least partially sustainable, and confer a wide range of nutritional and other benefits in addition to improving vitamin A status. Food-based approaches are sometimes described as expensive, but this is based on a narrow view. For example, biofortification and dissemination of sweet potatoes cost $9 to $30 per disability-life-year (DALY) gained, while that from VAS was estimated at the estimated cost effectiveness of VAS is $73 per DALY gained. From the community point of view, the economic benefits of food based approaches are likely to subsidize or outweigh their costs.

scholarly journals Cassava with enhanced β-carotene maintains adequate vitamin A status in Mongolian gerbils (Meriones unguiculatus) despite substantial cis-isomer content

2009 ◽  
Vol 102 (3) ◽  
pp. 342-349 ◽  
Author(s):  
Julie A. Howe ◽  
Bussie Maziya-Dixon ◽  
Sherry A. Tanumihardjo
Keyword(s):  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Meriones Unguiculatus ◽  
Provitamin A ◽  
Carotenoid Content ◽  
Mongolian Gerbils ◽  
Serum Retinol ◽  
Vitamin A Status ◽  
Isomer Content ◽  
Β Carotene

Efforts to increase β-carotene in cassava have been successful, but the ability of high-β-carotene cassava to prevent vitamin A deficiency has not been determined. Two studies investigated the bioefficacy of provitamin A in cassava and compared the effects of carotenoid content and variety on vitamin A status in vitamin A-depleted Mongolian gerbils (Meriones unguiculatus). Gerbils were fed a vitamin A-free diet 4 weeks prior to treatment. In Expt 1, treatments (ten gerbils per group) included 45 % high-β-carotene cassava, β-carotene and vitamin A supplements (intake matched to high-β-carotene cassava group), and oil control. In Expt 2, gerbils were fed cassava feeds with 1·8 or 4·3 nmol provitamin A/g prepared with two varieties. Gerbils were killed after 4 weeks. For Expt 1, liver vitamin A was higher (P < 0·05) in the vitamin A (1·45 (sd 0·23) μmol/liver), lower in the control (0·43 (sd 0·10) μmol/liver), but did not differ from the β-carotene group (0·77 (sd 0·12) μmol/liver) when compared with the high-β-carotene cassava group (0·69 (sd 0·20) μmol/liver). The bioconversion factor was 3·7 μg β-carotene to 1 μg retinol (2 mol:1 mol), despite 48 % cis-β-carotene [(Z)-β-carotene] composition in cassava. In Expt 2, cassava feed with 4·3 nmol provitamin A/g maintained vitamin A status. No effect of cassava variety was observed. Serum retinol concentrations did not differ. β-Carotene was detected in livers of gerbils receiving cassava and supplements, but the cis-to-trans ratio in liver differed from intake. Biofortified cassava adequately maintained vitamin A status and was as efficacious as β-carotene supplementation in the gerbil model.

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