scholarly journals Public Health Aspects in the Prevention and Control of Vitamin Deficiencies

2019 ◽  
Vol 3 (9) ◽  
Author(s):  
Ian Darnton-Hill
Keyword(s):  
Public Health ◽  
At Risk ◽  
Vitamin A ◽  
Vitamin A Deficiency ◽  
The Elderly ◽  
Micronutrient Deficiencies ◽  
Middle Income ◽  
Vitamin Deficiencies ◽  
Populations At Risk ◽  
And Control

ABSTRACT Vitamin deficiencies remain major etiological factors in the global burden of disease, especially in low- and middle-income countries. The purpose of this state-of-the-art review was to update current information on deficiencies of vitamins and public health approaches to addressing them. Some stages of life present a higher risk of deficiency than others: risks are higher in pregnant women, children (from conception to young childhood), adolescents, the elderly, and all of the over 800 million people globally who are undernourished. At risk are approximately 125 million preschool children with vitamin A deficiency, as well as sub-populations at risk of deficiencies of folate, thiamin, vitamin B12, niacin, riboflavin, other B vitamins. and vitamin D. Addressing micronutrient deficiencies requires identifying those at risk and then working to prevent and manage that risk. Public health approaches include improved, diversified diets; supplementation; fortification and biofortification; and other supportive public health measures. Historically, as with pellagra and beriberi and, in the last 3 decades, with vitamin A and folic acid, there has been encouraging progress, but much remains to be done.

New Issues in Developing Effective Approaches for the Prevention and Control of Vitamin A Deficiency

1998 ◽  
Vol 19 (2) ◽  
pp. 137-148 ◽  
Author(s):  
Martin W. Bloem ◽  
Saskia de Pee ◽  
Ian Darnton-Hill
Keyword(s):  
At Risk ◽  
Vitamin A ◽  
Prevention And Control ◽  
Control Strategies ◽  
Vitamin A Deficiency ◽  
Life Cycle Approach ◽  
Mortality And Morbidity ◽  
Increased Risk ◽  
To Come ◽  
And Control

Even mild to moderate vitamin A deficiency is now recognized as an important factor in child health and survival. This has given increased emphasis to the goal of virtually eliminating vitamin A deficiency and its consequences, including blindness, by the end of the decade. The implications of vitamin A deficiency, however, vary according to the group at risk, and this needs to be addressed when looking at ways to achieve the goal. In pre-school children, vitamin A deficiency can lead to increased risk of mortality and morbidity and to blindness. In pregnant and lactating women, it can lead to night-blindness and appears to have implications for maternal morbidity and mortality. Although the immediate health consequences for schoolchildren and adolescents are not completely known, they are probably less dramatic. Nevertheless, it is clear that there is a cross-generational cycle leading to and perpetuating vitamin A deficiency in affected communities. This also has implications when addressing prevention and control strategies. The existing, somewhat successful approach has been to target children aged six months to six years; it is implicit that this criterion is used to measure progress towards the end-of-decade goals. A broader, complementary, life-cycle approach to vitamin A deficiency is now appropriate in many countries. There is increasing emphasis on such approaches, i.e., fortifying foods with vitamin A and improving the diet, which address the whole population at risk. A mix of interventions will give governments the chance to shift from a subsidized vitamin A capsule programme to more sustainable, non-subsidized, consumer-funded vitamin A interventions, although in an appreciable number of countries, supplementation with vitamin A will be a necessity for some years to come. Guidelines to assist governments in such transitions are a high priority.

scholarly journals A Comparison of Vitamin A Status Among Elderly Chinese Population Between 2002 and 2012: A Cross-Sectional Analysis of the China National Nutrition and Health Survey

2020 ◽  
Vol 4 (Supplement_2) ◽  
pp. 1851-1851
Author(s):  
Rui Wang ◽  
Chen Jing ◽  
Yichun Hu ◽  
Xiaoguang Yang ◽  
Lichen Yang
Keyword(s):  
Public Health ◽  
Vitamin A ◽  
Health Survey ◽  
Vitamin A Deficiency ◽  
Public Health Problem ◽  
The Elderly ◽  
Serum Retinol ◽  
Nutrition And Health ◽  
Chinese Elderly ◽  
Vitamin A Status

Abstract Objectives Vitamin A deficiency is recognized as a major public health nutrition issue in developing countries including China. It is one of the most common micronutrient deficiencies, yet vitamin A status of the elderly in China paucity of data since 2002. We sought to evaluate Chinese elderly aged 60 years and above in vitamin A status, and to compare vitamin A insufficiency between year 2002 and 2012. Methods We compared serum retinol concentrations from the China National Nutrition and Health Survey 2002 (CNNHS 2002), with CNNHS data collected during 2010 through 2012 (CNNHS 2010–2012). Complete data were available for 4933 elderly participants in CNNHS 2002 and 5613 elderly participants in CNNHS 2010–2012. Results The mean serum retinol concentration was 1.69 (95% confidence interval (CI): 1.68–1.71) μmol/L during CNNHS 2002 and increase to 1.98 (1.96–2.00) μmol/L during CNNHS 2010–2012. Compared with 2002, the vitamin A levels in the elderly across all region, gender and age groups showed an upward trend, with the difference being statistically significant (all P < 0.05). In 2012, the incidence of VAD in the elderly participants was higher than in 2002 (3.39vs1.46) (P < 0.001). However, the incidence of marginal VAD was lower than in 2002 (7.38vs8.62) (P = 0.019). VAD in those being large cities, small and medium-sized cities, rural area, male and female, aged 60–69 or 70–79 were higher than in 2002 (all P < 0.05), poor rural areas was significantly lower than in 2002 (P < 0.001). The prevalence of marginal VAD among the urban elderly in 2012 was higher than in 2002 (P < 0.05), whereas the prevalence was lower than that in 2002 among the rural elderly (P < 0.001). The prevalence of marginal VAD in the male elderly (P < 0.001) and in the 60–69 age group (P = 0.014) were lower than in 2002. Conclusions Our findings showed that vitamin A status among elderly was greatly improved by 10 years, but VAD remains a public health problem in the Chinese elderly population. Therefore, reducing the incidence of VAD is crucial to the health of the elderly in China. In particular, attention needs to be paid to the nutrition and health status of urban and ≥80 year elderly. Funding Sources This research was supported by the Special Fund for Health-scientific Research in the Public Interest (No. 20,120,212) from the National Health and Family Planning Commission of the People's Republic of China.

scholarly journals Prevalence and Determinants of the Co-Occurrence of Overweight or Obesity and Micronutrient Deficiencies among Adults in the Philippines: Results from a National Representative Survey

Nutrients ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 2339
Author(s):  
Aileen R. de Juras ◽  
Wan-Chen Hsu ◽  
Susan C. Hu
Keyword(s):  
Vitamin A ◽  
Smoking Status ◽  
Vitamin A Deficiency ◽  
Wealth Quintile ◽  
The Philippines ◽  
Micronutrient Deficiencies ◽  
Nutrition Survey ◽  
Chi Square ◽  
Double Burden ◽  
Middle Income

The double burden of malnutrition (DBM) affects many low- and middle-income countries. However, few studies have examined DBM at the individual level, or undernutrition and overnutrition co-occurring within the same person. This study aims to investigate the prevalence and determinants of DBM among adults in the Philippines. Data from the 2013 National Nutrition Survey were used. The sample size in the analysis was 17,010 adults aged ≥20 years old, after excluding pregnant and lactating women. DBM was defined as the co-occurrence of overweight/obesity and anemia (definition #1), overweight/obesity and anemia or vitamin A deficiency (definition #2), and overweight/obesity and anemia or vitamin A deficiency or iodine insufficiency (definition #3). Anthropometric measurements and biochemical markers were used for DBM assessment. Data were analyzed using descriptive statistics, the chi-square test, and logistic regression by R software. Results showed that definition #3 is the predominant type of DBM (7.0%) in the general population, whereas the prevalence of DBM has increased to 23.7% in overweight/obese persons. Sex, age, educational attainment, marital status, household size, wealth quintile, and smoking status were the determinants of DBM. This study revealed that Filipino adults experience malnutrition critically and must be addressed through food and nutrition interventions.

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.

An Overview of the Ethics of Injury in Public Health

2019 ◽  
pp. 597-603
Author(s):  
Adnan A. Hyder
Keyword(s):  
Public Health ◽  
Injury Prevention ◽  
Prevention And Control ◽  
Public Health Ethics ◽  
Ethical Challenges ◽  
Middle Income ◽  
Middle Income Countries ◽  
Health Ethics ◽  
Prompt Attention ◽  
And Control

This chapter briefly introduces ethics issues in injury prevention and control in low- and middle-income countries (LMICs), using a series of examples that prompt attention to the ethical principles of autonomy and justice. The chapter also introduces the section of The Oxford Handbook of Public Health Ethics dedicated to an examination of injury and public health ethics, with attention given to the complex ethical challenges arising in injury prevention and control in LMICs. The section’s two chapters discuss public health ethics issues arising in the prevention and control of unintentional injuries and intentional injuries, respectively. Those chapters define a set of ethics issues within international injury work and provide an initial analysis of the nature of those ethics issues, their specificity, and potential pathways for addressing them.

Review of the Micronutrient Situation in Rwanda

2021 ◽  
Vol 42 (1) ◽  
pp. 133-154
Author(s):  
Joanne E. Arsenault ◽  
Deanna K. Olney
Keyword(s):  
Life Cycle ◽  
Young Children ◽  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Grey Literature ◽  
Age Groups ◽  
Reproductive Age ◽  
Micronutrient Deficiencies ◽  
Micronutrient Malnutrition ◽  
Context Specific

Background: Rwanda’s commitment to reducing malnutrition is evident in their multisectoral nutrition policy and wide array of nutrition partners. However, the prevalence of micronutrient deficiencies and the suitability of current strategies to address existing deficiencies is unclear. Objective: To review the available evidence related to the prevalence of micronutrient deficiencies across the life cycle and strategies in place to address them. Methods: We reviewed scientific and grey literature on nutritional problems in Rwanda, emphasizing micronutrient deficiencies and anemia, and current strategies to address micronutrient malnutrition. Results: Overall, there is scant evidence related to the types and prevalence of micronutrient deficiencies among populations across the life cycle in Rwanda. Existing evidence is primarily limited to outdated or small regional surveys focusing on iron or vitamin A among women and young children. Surveys have assessed the prevalence of anemia and indicate that anemia is very high among young children and moderately high among other age-groups. However, there are limited data on the context-specific causes of anemia in Rwanda across population groups. Current nutrition strategies mainly target women and young children and are primarily designed to reduce vitamin A deficiency and/or anemia caused by micronutrient deficiencies. Conclusions: Rwanda has many nutrition programs in place that address micronutrient deficiencies in young children and a few for women of reproductive age. However, gaps exist in knowledge of the extent of different types of micronutrient deficiencies among all populations across the life cycle and whether the delivery of nutrients through current programs is meeting actual needs.

scholarly journals Large-Scale Food Fortification and Biofortification in Low- and Middle-Income Countries: A Review of Programs, Trends, Challenges, and Evidence Gaps

2018 ◽  
Vol 39 (2) ◽  
pp. 315-331 ◽  
Author(s):  
Saskia J. M. Osendarp ◽  
Homero Martinez ◽  
Greg S. Garrett ◽  
Lynnette M. Neufeld ◽  
Luz Maria De-Regil ◽  
...  
Keyword(s):  
Large Scale ◽  
Food System ◽  
Food Fortification ◽  
Micronutrient Deficiencies ◽  
Middle Income ◽  
Middle Income Countries ◽  
Essential Components ◽  
Quality Of Delivery ◽  
And Control ◽  
Low And Middle Income

Background: Food fortification and biofortification are well-established strategies to address micronutrient deficiencies in vulnerable populations. However, the effectiveness of fortification programs is not only determined by the biological efficacy of the fortified foods but also by effective and sustainable implementation, which requires continual monitoring, quality assurance and control, and corrective measures to ensure high compliance. Objective: To provide an overview of efficacy, effectiveness, economics of food fortification and biofortification, and status of and challenges faced by large-scale food fortification programs in low- and middle-income countries (LMIC). Methods: A literature review of PubMed publications in English from 2000 to 2017, as well as gray literature, targeting nongovernmental organizations whose work focuses on this topic, complemented by national reports and a “snowball” process of citation searching. The article describes remaining technical challenges, barriers, and evidence gap and prioritizes recommendations and next steps to further accelerate progress and potential of impact. Results: The review identifies and highlights essential components of successful programs. It also points out issues that determine poor program performance, including lack of adequate monitoring and enforcement and poor compliance with standards by industry. Conclusions: In the last 17 years, large-scale food fortification initiatives have been reaching increasingly larger segments of populations in LMIC. Large-scale food fortification and biofortification should be part of other nutrition-specific and nutrition-sensitive efforts to prevent and control micronutrient deficiencies. There are remaining technical and food system challenges, especially in relation to improving coverage and quality of delivery and measuring progress of national programs.

Vitamin A deficiency - experience from a tertiary referral UK hospital; not just a low- and middle-income country issue

2021 ◽  
pp. 1-15
Author(s):  
Alexandra Marley ◽  
Samuel CL Smith ◽  
Ruhina Ahmed ◽  
Peter Nightingale ◽  
Sheldon C Cooper
Keyword(s):  
Vitamin A ◽  
Vitamin A Deficiency ◽  
Binary Logistic Regression ◽  
Signs And Symptoms ◽  
University Teaching ◽  
Serum Retinol ◽  
Middle Income ◽  
Reactive Protein ◽  
Active Inflammation ◽  
Low And Middle Income

Abstract Objective: Vitamin A (VA) deficiency, more common in low- and middle-income countries (LMIC) secondary to malnutrition, is associated with increased morbidity and mortality. The prevalence and impact of VA deficiency in high-income countries (HIC) where chronic conditions may predispose is less well understood. Setting: We examined the scale of low and deficient VA status in our tertiary University Teaching Hospital (HIC). Participants: Patients undergoing serum retinol concentrations 2012-2016 were identified from laboratory records, and records examined. Design: Interpretation of serum retinol may be affected by inflammation, so C-reactive protein (CRP) levels were sought. Binary logistic regression and generalised estimating equations were performed to review the relationship between CRP and VA. Results: 628 assays were requested, with 82 patients VA low (0.7-0.99umol/L) or deficient (<0.7umol/L). 16 patients were symptomatic (15 deficient), predominantly visual. Only one symptomatic patient’s VA deficiency was secondary to poor intake. Other symptomatic patients had chronic illnesses resulting in malabsorption. The incidence of a low VA level increases significantly with a raised CRP. Conclusion: The majority of patients tested either were replete or likely to have abnormal VA levels due to concomitant inflammation. A minority of patients had signs and symptoms of VA deficiency and was a cause of significant morbidity, but aetiology differs from LMIC, overwhelmingly malabsorption, most commonly secondary to surgery or hepatobiliary disease. A correlation between inflammation and low VA levels exists, which raises the possibility that requesting a VA level in an asymptomatic patient with active inflammation may be of questionable benefit.

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