scholarly journals Breast Milk–Derived Retinol Is a Potential Surrogate for Serum in the 13C-Retinol Isotope Dilution Test in Zambian Lactating Women with Vitamin A Deficient and Adequate Status

2020 ◽  
Vol 151 (1) ◽  
pp. 255-263
Author(s):  
Chisela Kaliwile ◽  
Charles Michelo ◽  
Jesse Sheftel ◽  
Christopher R Davis ◽  
Michael Grahn ◽  
...  
Keyword(s):  
Breast Milk ◽  
Vitamin A ◽  
Isotope Dilution ◽  
Policy Development ◽  
Demographic Data ◽  
Reproductive Age ◽  
Serum Retinol ◽  
Women Of Reproductive Age ◽  
Retinyl Acetate ◽  
Lactating Women

ABSTRACT Background Vitamin A (VA) deficiency (VAD) affects ∼19 million pregnant women worldwide. The extent of VAD in Zambian women of reproductive age is unknown owing to lack of survey inclusion or the use of static serum retinol concentrations, a low-sensitivity biomarker. Objectives This cross-sectional study employed isotopic techniques to determine VA status with serum and milk among women aged 18–49 y (n = 197) either lactating with infants aged 0–24 mo or nonlactating with or without infants. Methods Assistants were trained and piloted data collection. Demographic data, anthropometry, and relevant histories were obtained including malaria and anemia. For retinol isotope dilution (RID), baseline fasting blood and casual breast milk samples were collected before administration of 2.0 μmol 13C2-retinyl acetate and 24-h dietary recalls. On day 14, blood (n = 144) and milk (n = 66) were collected. Prevalence of total liver VA reserves (TLR) ≤0.10 μmol/g was defined as VAD with comparison to the DRI assumption of 0.07 μmol/g as minimally acceptable for North Americans. Results When a 20% adjustment for dose lost to milk was made in the RID equation for lactation, mean total body VA stores (TBS) for lactating women were 25% lower than for nonlactating women (P < 0.01), which was not the case without adjustment (P = 0.3). Mean ± SD TLR for all women were 0.15 ± 0.11 μmol/g liver. Using retinol purified from breast milk instead of serum for RID analysis yielded similar TBS and TLR, which were highly correlated between methods (P < 0.0001). Serum retinol ≤0.70 μmol/L had 0% sensitivity using either VAD liver cutoff and milk retinol ≤1.0 μmol/L had 42% sensitivity for VAD at 0.10 μmol/g. Conclusions Determining accurate VA status among women of reproductive age, especially lactating women, forms a basis for extrapolation to the general population and informing policy development and program implementation.

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 International Experiences in Assessing Vitamin A Status and Applying the Vitamin A-Labeled Isotope Dilution Method

2014 ◽  
Vol 84 (Supplement 1) ◽  
pp. 40-51 ◽  
Author(s):  
Veronica Lopez-Teros ◽  
Justin Chileshe ◽  
Nicole Idohou-Dossou ◽  
Tetra Fajarwati ◽  
Gabriel Medoua Nama ◽  
...  
Keyword(s):  
Vitamin A ◽  
Dose Response ◽  
Isotope Dilution ◽  
Qualitative Assessment ◽  
Isotope Dilution Method ◽  
Dilution Method ◽  
Serum Retinol ◽  
Retinyl Acetate ◽  
Positive Effects ◽  
Vitamin A Status

Inadequate vitamin A (VA) nutrition continues to be a major problem worldwide, and many interventions being implemented to improve VA status in various populations need to be evaluated. The interpretation of results after an intervention depends greatly on the method selected to assess VA status. To evaluate the effect of an intervention on VA status, researchers in Cameroon, India, Indonesia, Mexico, Senegal and Zambia have used serum retinol as an indicator, and have not always found improvement in response to supplementation. One problem is that homeostatic control of serum retinol may mask positive effects of treatment in that changes in concentration are observed only when status is either moderately to severely depleted or excessive. Because VA is stored mainly in the liver, measurements of hepatic VA stores are the “gold standard” for assessing VA status. Dose response tests such as the relative dose response (RDR) and the modified relative dose response (MRDR), allow a qualitative assessment of VA liver stores. On the other hand, the use of the vitamin A-labeled isotope dilution (VALID) technique, (using 13C or 2H-labeled retinyl acetate) serves as an indirect method to quantitatively estimate total body and liver VA stores. Countries including Cameroon, China, Ghana, Mexico, Thailand and Zambia are now applying the VALID method to sensitively assess changes in VA status during interventions, or to estimate a population’s dietary requirement for VA. Transition to the use of more sensitive biochemical indicators of VA status such as the VALID technique is needed to effectively assess interventions in populations where mild to moderate VA deficiency is more prevalent than severe deficiency.

scholarly journals Prevalence and Associated Factors of Vitamin A Deficiency among Children and Women in Senegal

2020 ◽  
Vol 8 (2) ◽  
pp. 1-11
Author(s):  
Mane Hélène Faye ◽  
Nicole Idohou-Dossou ◽  
Abdou Badiane ◽  
Anta Agne-Djigo ◽  
Papa Mamadou DD Sylla ◽  
...  
Keyword(s):  
Socioeconomic Status ◽  
Logistic Regression ◽  
Vitamin A ◽  
Pregnant Women ◽  
Vitamin A Deficiency ◽  
Plasma Concentrations ◽  
Reproductive Age ◽  
Subclinical Inflammation ◽  
Women Of Reproductive Age ◽  
Factors Associated

Background: Like many developing countries, Senegal does not have data on the extent of vitamin A deficiency (VAD) that is representative of its population. The present survey was conducted to fill this gap and to identify factors associated with VAD, prior to the introduction of a large-scale vitamin A oil fortification program. Procedures: A nationwide representative cross-sectional survey involving 1887 children 12 to 59 months old and 1316 women of reproductive age (WRA) was conducted. Blood samples were collected and plasma concentrations of retinol (PR), C-reactive protein (CRP), and alpha-1-acidglycoprotein were measured. PR was adjusted for subclinical inflammation using the BRINDA regression methodology. Multivariate logistic regression was used to identify factors associated with VAD. Findings: The adjusted prevalence of VAD (PR ≤ 0.7 μmol/L) in children was 15.3% and differed by age group, area of residence, and socioeconomic status and half of them had subclinical inflammation. Among WRA, VAD was low (2.3%) and 18.1% had vitamin A insufficiency (VAI). Pregnant women were more affected by VAI (28.4%) and Dakar had lower figures compared with other cities and rural strata. Prevalence of VAI decreased with increasing wealth quintile. In logistic regression, abnormal CRP, poverty, scarce consumption of poultry, oysters, melon, red palm oil, palm kernel oil, Saba senegalensis fruit pulp (Maad) and cowpea, frequent consumption of leeks and consumption of Leptadenia hastata leaves (Mbuum tiakhat), were associated with VAD in children. For women, lower socioeconomic status, fair or poor health status and anemia were negatively associated with VAI. Conclusions: In Senegal, VAD is a moderate public health problem in children and slight among women. Particular attention should be paid to children older than 23 months, pregnant women, rural populations, and poorest households. Nutritional interventions should be implemented alongside morbidity prevention and control. Keywords: vitamin A deficiency, children 12-59 months, women of reproductive age, Senegal.

scholarly journals Vitamin A intake of Brazilian mothers and retinol concentrations in maternal blood, human milk, and the umbilical cord

2018 ◽  
Vol 46 (4) ◽  
pp. 1555-1569 ◽  
Author(s):  
Thalia Manfrin Martins Deminice ◽  
Ivan Savioli Ferraz ◽  
Jacqueline Pontes Monteiro ◽  
Alceu Afonso Jordão ◽  
Lívia Maria Cordeiro Simões Ambrósio ◽  
...  
Keyword(s):  
Breast Milk ◽  
Vitamin A ◽  
Human Milk ◽  
Pregnant Women ◽  
Umbilical Cord ◽  
Maternal Blood ◽  
Maternal Serum ◽  
Serum Retinol ◽  
Cross Sectional ◽  
Blood Samples

Objectives To analyse intake of vitamin A (VA) and retinol concentrations in maternal blood, breast milk (BM), and the umbilical cord (UC) of newborns, and to determine the associations among these variables. Methods We performed a cross-sectional, epidemiological study of 180 mother–newborn dyads. Maternal and UC blood samples and BM were collected. VA intake by the mother over 30 days was assessed using a questionnaire. Results Mean retinol concentrations in maternal serum, the UC, and BM were 0.65 ± 0.27, 0.36 ± 0.18, and 2.95 ± 2.70 µmol/L, respectively. Retinol concentrations <0.70 µmol/L were found in 57.2% of maternal blood samples and in 94.9% of UC samples. A total of 27.9% of BM samples showed retinol concentrations <1.05 µmol/L. Mean VA intake by the mothers was 1041.33 ± 1187.86 µg retinol activity equivalents/day and was inadequate (<550 µg retinol activity equivalents/day) in 44.7%. Conclusions High proportions of insufficient retinol concentrations were observed in the UC, maternal blood, and BM. A high percentage of pregnant women had inadequate VA intake. Mothers with insufficient serum retinol concentrations had newborns with lower retinol concentrations in the UC. Higher retinol concentrations were observed in maternal blood and the UC with a higher VA intake.

Effect of vitamin A supplementation in women of reproductive age on maternal survival in Ghana (ObaapaVitA): a cluster-randomised, placebo-controlled trial

The Lancet ◽  
2010 ◽  
Vol 375 (9726) ◽  
pp. 1640-1649 ◽  
Author(s):  
Betty R Kirkwood ◽  
Lisa Hurt ◽  
Seeba Amenga-Etego ◽  
Charlotte Tawiah ◽  
Charles Zandoh ◽  
...  
Keyword(s):  
Vitamin A ◽  
Controlled Trial ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Vitamin A Supplementation ◽  
Cluster Randomised ◽  
Maternal Survival

P-719 Self-declared infertility and child desire among women of reproductive age in the National Survey of Demography and Health, Brazil

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
S Garcia ◽  
M Koyama
Keyword(s):  
Black Women ◽  
Health Services ◽  
National Survey ◽  
Demographic Data ◽  
Processing System ◽  
Public Health Problem ◽  
Reproductive Age ◽  
Women Of Reproductive Age ◽  
Cross Sectional ◽  
Contraception Use

Abstract Study question This article aims to characterize from a socio-demographic point of view, women of reproductive age who wish to have children, declared themselves infertile, and their search for treatments and outcomes. Summary answer It is essential to develop specific population surveys on infertility in Brazil to identify its magnitude and main economic and social components. What is known already Commonly neglected in developing countries where public policy is incipient, infertility brings social, economic and psychological consequences to couples. It is considered as a serious public health problem whose impact varies among different populations and acquires relevance for specific communities. In Brazil, there are no clinical or demographic data that point us to the magnitude of the problem, its social characteristics and impact. Taking into account the postponement of motherhood for after 30 years, there will probably be an increase in the number of women and couples who may resort to infertility treatments to fulfil the desire for procreation. Study design, size, duration The National Survey of Demography and Health of Women and Children (PNDS) is a cross-sectional study and a household complex probabilistic sampling. The sampling units were selected according to a stratified model of simple random conglomerates in two stages: lottery draw and household draw. The last survey was conducted between June 2006 and May 2007 in 14,617 households. In the selected households, interviews were conducted with 15,575 women of reproductive age. Participants/materials, setting, methods The participants consisted of 15.575 women between 15 and 49 years, representative of the five Brazilian macro-regions. The information was obtained through questionnaires, applied in person, raising information on fertility, fecundity, contraception, use of health services and socioeconomic profile. The interviewer’s team was formed by approximately 100 people and 27 supervisors, all-female, divided into nine regional teams. The system used for data entry was the Census and Survey Processing System - CSPro. Main results and the role of chance The survey results indicate that of women who wish to have children, 9.2% declared themselves infertile; 50,8% of them sought health services for treatment; non-black women had higher percentages of demand compared to black women (62.4% versus 41.3%). Also, there were higher percentages of seeking help from women belonging to classes A (61.2%), B (83.3%) and C (60.9%) compared to those belonging to classes D (30.4%) and E (7.8%) On the other side, almost half of women did not seek help to get pregnant (49,1%); this percentage is higher among black women (58%). Moreover, women in classes D and E had the highest percentages of non-demand, 69.6% and 92.2%, respectively. The reasons cited for those who do not seek help, are “I think there is no solution” (54,7%); “I don’t think I can get help” (17.3%), “financial reasons” (26.8%) or “I don’t know where to get it” (1,2%). Among those who sought help, 48,5% are under treatment, 24,4 % said there is no solution; 15,8% are waiting for service and 11,3% have no money for treatment. Significance limit was established for values of p &lt; 0.05. The analysis was performed in the programs Stata v.9 and/or SPSS v.14. Limitations, reasons for caution The limitations of the study are recognized. Firstly, opinions are restricted to the moment of the interview and, thus, the desire for children may change over time. Secondly, the statement of infertility is based on self-declaration, not on clinical diagnosis. Wider implications of the findings This is the first study based on PNDS 2006 data on infertility and demand for treatments in Brazil. It can contribute to providing insights, raising new questions and discovering relevant categories and dimensions of analysis to be taken into account in future studies and surveys. Trial registration number not applicable

scholarly journals Vitamin A-fortified cooking oil reduces vitamin A deficiency in infants, young children and women: results from a programme evaluation in Indonesia

2015 ◽  
Vol 18 (14) ◽  
pp. 2511-2522 ◽  
Author(s):  
Sandjaja ◽  
Idrus Jus’at ◽  
Abas B Jahari ◽  
Ifrad ◽  
Min Kyaw Htet ◽  
...  
Keyword(s):  
Vitamin A ◽  
Nutrient Intake ◽  
Vitamin A Deficiency ◽  
Retinyl Palmitate ◽  
Oil Consumption ◽  
Serum Retinol ◽  
Cross Sectional ◽  
Lactating Women ◽  
Dietary Recall ◽  
Poor Households

AbstractObjectiveTo assess oil consumption, vitamin A intake and retinol status before and a year after the fortification of unbranded palm oil with retinyl palmitate.DesignPre–post evaluation between two surveys.SettingTwenty-four villages in West Java.SubjectsPoor households were randomly sampled. Serum retinol (adjusted for subclinical infection) was analysed in cross-sectional samples of lactating mothers (baselinen324/endlinen349), their infants aged 6–11 months (n318/n335) and children aged 12–59 months (n469/477), and cohorts of children aged 5–9 years (n186) and women aged 15–29 years (n171), alongside food and oil consumption from dietary recall.ResultsFortified oil improved vitamin A intakes, contributing on average 26 %, 40 %, 38 %, 29 % and 35 % of the daily Recommended Nutrient Intake for children aged 12–23 months, 24–59 months, 5–9 years, lactating and non-lactating women, respectively. Serum retinol was 2–19 % higher at endline than baseline (P<0·001 in infants aged 6–11 months, children aged 5–9 years, lactating and non-lactating women; non-significant in children aged 12–23 months;P=0·057 in children aged 24–59 months). Retinol in breast milk averaged 20·5 μg/dl at baseline and 32·5 μg/dl at endline (P<0·01). Deficiency prevalence (serum retinol <20 μg/dl) was 6·5–18 % across groups at baseline, and 0·6–6 % at endline (P≤0·011). In multivariate regressions adjusting for socio-economic differences, vitamin A intake from fortified oil predicted improved retinol status for children aged 6–59 months (P=0·003) and 5–9 years (P=0·03).ConclusionsAlthough this evaluation without a comparison group cannot prove causality, retinyl contents in oil, Recommended Nutrient Intake contributions and relationships between vitamin intake and serum retinol provide strong plausibility of oil fortification impacting vitamin A status in Indonesian women and children.

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