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 Serum retinyl esters are positively correlated with analyzed total liver vitamin A reserves collected from US adults at time of death

2018 ◽  
Vol 108 (5) ◽  
pp. 997-1005 ◽  
Author(s):  
Kiersten Olsen ◽  
Devika J Suri ◽  
Christopher Davis ◽  
Jesse Sheftel ◽  
Kohei Nishimoto ◽  
...  
Keyword(s):  
Vitamin A ◽  
Ultra Performance Liquid Chromatography ◽  
Total Serum ◽  
Serum Retinol ◽  
Hypervitaminosis A ◽  
Individual Level ◽  
Total Liver ◽  
Retinyl Esters ◽  
The Individual ◽  
Liver Vitamin

ABSTRACT Background Minimal human data exist on liver vitamin A (VA) compared with serum biomarkers. Cutoffs of 5% and 10% total serum VA as retinyl esters (REs) suggest a VA intoxication diagnosis. Objectives We compared total liver VA reserves (TLRs) with the percentage of total serum VA as REs to evaluate hypervitaminosis with the use of US adult autopsy samples. Secondary objectives evaluated serum retinol sensitivity, TLRs among lobes, and hepatic α-retinol concentrations, an α-carotene cleavage product. Design Matched serum and liver samples were procured from cadavers (n = 27; mean ± SD age: 70.7 ± 14.9 y; range: 49–101 y). TLRs and α-REs were quantified by ultra-performance liquid chromatography. Pearson correlations showed liver and serum associations. Sensitivity and specificity were calculated for >5%, 7.5%, and 10% total serum VA as REs to predict TLRs and for serum retinol <0.7 and 1 μmol/L to predict deficiency. Results Serum RE concentrations were correlated with TLRs (r = 0.497, P < 0.001). Nine subjects (33%) had hypervitaminosis A (≥1.0 μmol VA/g liver), 2 of whom had >7.5% total serum VA as REs; histologic indicators corroborated toxicity at 3 μmol/g liver. No subject had >10% total serum VA as REs. Serum retinol sensitivity to determine deficiency (TLRs <0.1 μmol VA/g) was 83% at 0.7 and 1 μmol/L. Hepatic α-retinol was positively correlated with age (P = 0.047), but removing an outlier nullified significance. Conclusions This study evaluated serum REs as a biomarker of VA status against TLRs (gold standard), and abnormal histology suggested that 7.5% total serum VA as REs is diagnostic for toxicity at the individual level in adults. The long-term impact of VA supplements and fortificants on VA status is currently unknown. Considering the high prevalence of hypervitaminotic TLRs in this cohort, and given that many countries are adding preformed VA to processed products, population biomarkers diagnosing hypervitaminosis before toxicity are urgently needed. This trial was registered at clinicaltrials.govas NCT03305042.

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.

scholarly journals Effect of African leafy vegetables on the micronutrient status of mildly deficient farm-school children in South Africa: a randomized controlled study

2015 ◽  
Vol 19 (5) ◽  
pp. 935-945 ◽  
Author(s):  
Marinka van der Hoeven ◽  
Mieke Faber ◽  
Jennifer Osei ◽  
Annamarie Kruger ◽  
Cornelius M Smuts
Keyword(s):  
South Africa ◽  
Randomized Controlled Trial ◽  
Vitamin A ◽  
Serum Ferritin ◽  
Controlled Trial ◽  
Leafy Vegetables ◽  
Serum Retinol ◽  
School Meal ◽  
Randomized Controlled ◽  
Serum Zn

AbstractObjectiveA randomized controlled trial was conducted to assess the effect of African leafy vegetable (ALV) consumption on Fe, Zn and vitamin A status in children.DesignChildren were randomly allocated to receive either a 300 g cooked ALV dish and school meal starch (n86) or the normal school meal (n81) five times per week for three months. ALV in the dish consisted mainly ofAmaranthus cruentus(at least 80 %) and the remainder ofCleome gynandra,Cucurbita maximaorVigna unguiculata. Nutrient content and consumer acceptance of the ALV dish were also determined.SettingNorth West Province, South Africa.SubjectsGrade R to grade 4 children (6–12 years old) of two farm schools.ResultsThe ALV dish contributed 11·6–15·8 mg Fe and 1·4–3·7 mg Zn. At baseline, prevalence of deficiencies in the intervention group was 16·0 %, 16·3 %, 7·0 % and 75·6 %, respectively, for anaemia (Hb<11·5 g/dl), Fe (serum ferritin<15 µg/l), vitamin A (serum retinol<20 μg/dl) and Zn (serum Zn<65 μg/dl); and in the control group 10·5 %, 18·5 %, 2·5 % and 75·3 %, respectively. No significant estimated intervention effect was found.ConclusionsThis randomized controlled trial showed that ALV were unable to improve serum retinol, serum ferritin or Hb if there are only mild deficiencies present. Furthermore, despite the low Zn status in the study population, ALV consumption did not improve serum Zn concentrations either.

Simultaneous determination of retinol and retinyl esters in serum or plasma by reversed-phase high-performance liquid chromatography.

1978 ◽  
Vol 24 (11) ◽  
pp. 1920-1923 ◽  
Author(s):  
M G DeRuyter ◽  
A P De Leenheer
Keyword(s):  
Vitamin A ◽  
High Performance ◽  
Chromatographic Determination ◽  
Reversed Phase ◽  
Retinyl Palmitate ◽  
Serum Retinol ◽  
Liquid Chromatographic Determination ◽  
Retinyl Esters ◽  
Liquid Chromatographic

Abstract We propose a single-run liquid-chromatographic determination, with ultraviolet detection at 330 nm, for serum retinol and retinyl esters. The vitamin A derivatives are extracted according to the Bligh-Dyer procedure. With 200 microliter or serum, the lower detection limit is 50 microgram/liter for retinol and about 100 microgram/liter for retinyl esters. Within-run precision (CV) was 2.3% for retinol, 4.3% for retinyl palmitate. Day-to-day percision (CV, n = 20) for retinol was 4.9% during a month. The method can be used for the assessment of vitamin A absorption tests and for the determination of serum retinol (normal, subnormal, and above-normal concentrations). Serum retinyl esters can only be measured in conditions where concentrations exceed 100 microgram/liter.

scholarly journals Liver is widely eaten by preschool children in the Northern Cape province of South Africa: Implications for routine vitamin A supplementation

2019 ◽  
Vol 16 (3) ◽  
Author(s):  
Martha E. Stuijvenberg ◽  
Serina E. Schoeman ◽  
Jana Nel ◽  
Maretha Roux ◽  
Muhammad A. Dhansay
Keyword(s):  
South Africa ◽  
Preschool Children ◽  
Vitamin A ◽  
Vitamin A Supplementation ◽  
Northern Cape

scholarly journals Daily consumption of pro-vitamin A biofortified (yellow) cassava improves serum retinol concentrations in preschool children in Nigeria: a randomized controlled trial

2020 ◽  
Vol 113 (1) ◽  
pp. 221-231
Author(s):  
Ibukun Afolami ◽  
Martin N Mwangi ◽  
Folake Samuel ◽  
Erick Boy ◽  
Paul Ilona ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Preschool Children ◽  
Vitamin A ◽  
Controlled Trial ◽  
Asymptomatic Malaria ◽  
Serum Retinol ◽  
Daily Consumption ◽  
Randomized Controlled ◽  
Vitamin A Status ◽  
Β Carotene

ABSTRACT Background Vitamin A deficiency is a public health problem in sub-Saharan Africa. Pro-vitamin A biofortified (yellow) cassava has the potential to contribute significantly to improve vitamin A status, especially in populations that are difficult to reach with other strategies. Objectives The study aimed at determining the efficacy of biofortified cassava to improve vitamin A status of Nigerian preschool children. Methods An open-label randomized controlled trial was conducted in southwestern Nigeria. In total, 176 preschool children (aged 3–5 y) were randomized into 2 parallel arms comprising an experimental group (n = 88), fed foods prepared from biofortified (yellow) cassava, and a control group (n = 88), fed foods prepared from white cassava, twice a day, 6 d a week for 93 d. Results A total of 159 children completed the trial (yellow cassava group, n = 80; white cassava group, n = 79). Children consumed 221 and 74 µg/d retinol activity equivalents from intervention foods in the yellow and white cassava groups, respectively. The treatment effect on serum retinol concentrations at the end of the feeding trial was 0.06 µmol/L (95% CI: 0.004, 0.124 µmol/L), after adjustment for baseline retinol concentrations, inflammation, and asymptomatic malaria status. No significant treatment effects were detected for serum β-carotene (adjusted effect: 3.9%; 95% CI: −0.6%, 8.6%) and gut permeability (adjusted effect: 0.002; 95% CI: −0.089, 0.092), but a significant effect was detected for hemoglobin concentrations (adjusted effect: 3.08 g/L; 95% CI: 0.38, 5.78 g/L). Conclusions Daily consumption of β-carotene from biofortified cassava improved serum retinol and hemoglobin concentrations modestly in Nigerian preschool children. This study was registered with clinicaltrials.gov as NCT02627222.

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.

scholarly journals Retinol isotope dilution accurately predicts liver reserves in piglets but overestimates reserves in lactating sows

2019 ◽  
Vol 244 (7) ◽  
pp. 579-587 ◽  
Author(s):  
Jesse Sheftel ◽  
Rebecca L Surles ◽  
Sherry A Tanumihardjo
Keyword(s):  
Vitamin A ◽  
Isotope Dilution ◽  
Equilibration Time ◽  
Serum Retinol ◽  
Retinyl Acetate ◽  
Hypervitaminosis A ◽  
Post Dose ◽  
Human Infants ◽  
Lactating Women ◽  
Lactating Sows

Retinol isotope dilution (RID) is used to estimate total body vitamin A (VA) stores in groups to assess VA status. Metabolic differences during lactation may affect RID calculations as currently applied. We evaluated the time required for isotopic equilibration between serum and liver retinol in piglets, and the utility of milk retinol isotopic enrichment as a proxy for serum in lactating sows. Piglets ( n = 24) and sows ( n = 6) were fed 1.75 or 20 µmol 13 C2-retinyl acetate, respectively. Piglets ( n = 5 or 7) were killed on d 0, 4, 7, or 14. Blood and milk were collected at d 0, 0.5, 1, 2, 4, 7, 10, 14, and 21 before the sows were killed to collect liver. Retinol 13 C-enrichment was determined by gas chromatography-combustion-isotope ratio mass spectrometry. Equilibration time and RID-predicted liver VA reserves were calculated. In piglets, serum and liver retinol 13 C-enrichment differed significantly in individuals at d 4 and 7 ( P = 0.008, 0.03) but not d 14 ( P = 0.06); however, mean values were not different by d 4 ( P = 0.62). Current RID equations accurately predicted VA deficiency (means ≤0.027 µmol/g liver) in the piglets. In sows, milk and serum retinol 13 C-enrichment reached equilibrium between 2 and 7 d post-dose. After correcting for dose lost to milk, RID equations predicted higher liver stores than measured values even though the serum to liver atom % was 1.00 ± 0.01 at kill. In VA deficient infants, a shorter period may be accurate in population-level RID studies when using appropriate assumptions. In lactating women, the RID may have decreased accuracy due to variable losses of tracer in milk. Furthermore, assumptions about storage and loss of the dose in milk must be evaluated in lactating women considering the observed discrepancy between predicted and measured stores. Impact statement Vitamin A (VA) deficiency and hypervitaminosis A have been reported in groups of people worldwide. Conventional biomarkers of VA deficiency (e.g. serum retinol concentration, dose response tests) are not able to distinguish between sufficiency and hypervitaminosis A. Retinol isotope dilution (RID) predictions of VA status have been validated in humans and animal models from deficiency through toxicity; however, RID during life stages with unique issues related to isotopic tracing, such as infancy and lactation, requires further evaluation. This study investigated RID in piglets and lactating sows as models for human infants and women. In piglets, RID successfully determined VA deficiency (confirmed with liver analysis), and that the tracer mixes quickly. Conversely, in lactating sows, although serum and milk enrichments were similar, traditional RID equations overestimated VA stores, likely due to losses of tracer and higher extrahepatic VA storage than predictions. These data inform researchers about the challenges of using RID during lactation.

scholarly journals A single dose of vitamin A improves haemoglobin concentration, retinol status and phagocytic function of neutrophils in preschool children

2009 ◽  
Vol 103 (6) ◽  
pp. 798-802 ◽  
Author(s):  
Claudia Jimenez ◽  
Irene Leets ◽  
Rafael Puche ◽  
Elsy Anzola ◽  
Rosa Montilla ◽  
...  
Keyword(s):  
Single Dose ◽  
Preschool Children ◽  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Transferrin Saturation ◽  
Haemoglobin Concentration ◽  
Phagocytic Function ◽  
Serum Retinol ◽  
Phagocytic Capacity ◽  
Hb Concentration

Since there is a reported interrelationship between vitamin A and Fe metabolism, and with immunological response, the objective was to evaluate the effect of a single dose of vitamin A administered to preschool children, on Fe and vitamin A nutritional status, anaemia and phagocytic function of neutrophils, 30 d after supplementation. A total of eighty children (sixty-eight supplemented and twelve controls) were supplemented orally with 200 000 IU (60 mg) vitamin A, and evaluated for nutritional, haematological and immunological responses at the beginning of the study and 30 d after supplementation. Parameters studied included Hb, serum ferritin, retinol and Fe concentrations, transferrin saturation, IL-4, interferon-γ and phagocityc capacity of neutrophils using non-fluorescent latex microbeads. After supplementation there was a significant increase in Hb concentration (P = 0·03), mean corpuscular Hb concentration (P = 0·001) and serum retinol (P = 0·0078). Prevalences of anaemia and vitamin A deficiency decreased significantly from 17·6 % to 13·2 % and from 25 % to 13·2 %, respectively. Regarding phagocytic function, there was a significant increase in the number of microbeads engulfed by neutrophils (P < 0·05) and no significant changes in cytokine concentrations at 1 month after treatment. A single dose of 200 000 IU (60 mg) vitamin A administered orally to a group of preschool children with a high prevalence of vitamin A deficiency enhanced serum retinol and Hb concentrations, decreased the prevalence of anaemia and vitamin A deficiency and improved the constitutive phagocytic capacity of neutrophils. Vitamin A supplementation could help to decrease vitamin A deficiency, anaemia prevalence and to improve the innate immunity response in preschool children. The effects were obtained without Fe supplementation.

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