Vitamin A supplementation for cystic fibrosis

BACKGROUND

People with cystic fibrosis and pancreatic insufficiency are at risk of fat soluble vitamin deficiency as these vitamins (A, D, E and K) are co-absorbed with fat. Thus, some cystic fibrosis centres routinely administer these vitamins as supplements but the centres vary in their approach of addressing the possible development of deficiencies in these vitamins. Vitamin A deficiency causes predominantly eye and skin problems while supplementation of vitamin A to excessive levels may cause harm to the respiratory and skeletal systems in children. Thus a systematic review on vitamin A supplementation in people with cystic fibrosis would help guide clinical practice.

OBJECTIVES

To determine if vitamin A supplementation in children and adults with CF:(1) reduces the frequency of vitamin A deficiency disorders;(2) improves general and respiratory health;(3) increases the frequency of vitamin A toxicity.

SEARCH STRATEGY

We searched the Cochrane Cystic Fibrosis and Genetic Disorders Group Trials Register which comprises of references identified from comprehensive electronic database searches and handsearches of relevant journals and abstract books of conference proceedings. Date of the most recent search of the Group's Cystic Fibrosis Trials Register: July 2007.

SELECTION CRITERIA

All randomised or quasi-randomised controlled trials comparing all preparations of oral vitamin A used as a supplement compared to either no supplementation (or placebo) at any dose and for any duration, in children or adults with cystic fibrosis (defined by sweat tests or genetic testing) with and without pancreatic insufficiency.

DATA COLLECTION AND ANALYSIS

No relevant studies were identified in the search.

MAIN RESULTS

No studies were included in this review.

AUTHORS' CONCLUSIONS

As there were no randomised or quasi-randomised controlled trials identified, we cannot draw any conclusions on the benefits (or otherwise) of regular administration of vitamin A in people with cystic fibrosis. Until further data are available, country or region specific guidelines on the use of vitamin A in people with cystic fibrosis should be followed.

Vitamin A supplementation in Cambodia: program coverage and association with greater maternal formal education

Vitamin A supplementation reduces morbidity, mortality, and blindness among children in developing countries. The objective of this study is to characterize the coverage of the Cambodian national vitamin A program among preschool children and to identify risk factors for not receiving vitamin A supplementation. The study subjects were preschool children and their families who participated in the 2005 Cambodian Demographic and Health Survey (CDHS), a nationally representative survey. Of 1,547 preschool children, aged 12-59 months, 42.8% received a vitamin A capsule within the last six months. There were no significant differences in paternal education, child age, fever within the last 2 weeks, stunting, underweight, or wasting between children who did or did not receive a vitamin A capsule. Maternal education of > or =10 years (Odds Ratio [OR] 2.09, 95% Confidence Interval [CI] 1.02-4.29), 7-9 years (OR 1.46, 95% CI 0.99-2.15), 4-6 years (OR 1.71, 95% CI 1.26-2.32), and 1-3 years (OR 1.50, 95% CI 1.10-2.06) was associated with the child receiving a vitamin A capsule compared to no formal education in multivariate analyses adjusting for other potential confounders. The national vitamin A supplementation program in Cambodia did not reach over one-half of preschool children in 2005. Greater maternal formal education appears to be an important determinant for receipt of a vitamin A capsule by preschool children.

Determinants of high vitamin A supplementation coverage among pre-school children in Mali: the National Nutrition Weeks experience

Objectives

To assess vitamin A supplementation (VAS) coverage of children aged 6–59 months and the factors that favour or limit this coverage during the National Nutrition Weeks in Mali.

Design

Cross-sectional study. Interviews about demographic factors and children's adherence to the vitamin A capsule distribution programme were conducted. Professionals' knowledge of vitamin A and various aspects related to the supplementation strategy were assessed.

Setting

Five regions out of the eight regions in the country, in addition to Bamako District. Three rural communes were selected in three regions to represent rural areas.

Subjects

Parents or caregivers of children under 5 years of age, health agents who participated in the weeks, and community and administrative leaders.

Results

At least 80% of the children received the supplement. More ‘traditional’ communication channels (town criers, friends and family members) appeared to be more effective in reaching the target groups than modern methods, i.e. radio and television. Mothers' possession of a radio (Pearson χ2 = 5.03; P = 0.025) and fathers' education (Pearson χ2 = 19.02; P < 0.001), possession of a radio (Pearson χ2 = 8.93; P = 0.003) and listening to it (Pearson χ2 = 7.62; P = 0.006) all appeared to be statistically and significantly associated with children's coverage. In multivariate logistic regression analysis, only the study site (urban/rural) (P = 0.004), ‘traditional channels’ (P = 0.02) and fathers' education (P = 0.04) were significantly associated with children's coverage. Knowledge about VAS was high among community and administrative leaders, and health professionals. The planning and implementation of activities at the district level were found to be good in general.

Conclusion

National Nutrition Weeks provide a successful example of a periodic VAS strategy with high coverage among children aged 6–59 months in Mali. Campaigns aimed at informing and sensitising populations during the Nutrition Weeks should also target children's fathers.

An evaluation of infant immunization in Africa: is a transformation in progress?

OBJECTIVE

To assess the progress made towards meeting the goals of the African Regional Strategic Plan of the Expanded Programme on Immunization between 2001 and 2005.

METHODS

We reviewed data from national infant immunization programmes in the 46 countries of WHOs African Region, reviewed the literature and analysed existing data sources. We carried out face-to-face and telephone interviews with relevant staff members at regional and subregional levels.

FINDINGS

The African Region fell short of the target for 80% of countries to achieve at least 80% immunization coverage by 2005. However, diphtheria-tetanus-pertussis-3 coverage increased by 15%, from 54% in 2000 to 69% in 2004. As a result, we estimate that the number of nonimmunized children declined from 1.4 million in 2002 to 900,000 in 2004. In 2004, four of seven countries with endemic or re-established wild polio virus had coverage of 50% or less, and some neighbouring countries at high risk of importation did not meet the 80% vaccination target. Reported measles cases dropped from 520,000 in 2000 to 316,000 in 2005, and mortality was reduced by approximately 60% when compared to 1999 baseline levels. A network of measles and yellow fever laboratories had been established in 29 countries by July 2005.

CONCLUSION

Rates of immunization coverage are improving dramatically in the WHO African Region. The huge increases in spending on immunization and the related improvements in programme performance are linked predominantly to increases in donor funding.

Avaliação de políticas públicas de segurança alimentar e combate à fome no período 1995-2002. 3 - o Programa Nacional de Controle da Deficiência de Vitamina A

A distribuição de vitamina A em Dias Nacionais de Vacinação ocorre desde 1983; o Brasil foi pioneiro nesse tipo de intervenção. O estudo avaliou o programa no período de 1995-2002 na perspectiva de estrutura-processo-resultado. A metodologia envolveu pesquisa documental, entrevistas com gestores e estudo de caso em 44 municípios da Bahia, resultando em 1.344 questionários domiciliares. Em relação à estrutura, o programa operou sem instrumento normativo a partir de 1998, decorrente da extinção do Instituto Nacional de Alimentação e Nutrição. Melhorias nos processos de aquisição e distribuição do suplemento impactaram positivamente na sua cobertura; em 2002, foram distribuídas 3,5 milhões de cápsulas (cobertura 72%). Nas 2.546 crianças estudadas na Bahia, não houve regularidade na distribuição e a cobertura anual variou de 8% a 26%. As limitações de tempo e recursos humanos, informadas pelos gestores, corroboram a hipótese de que essa estratégia não contribui para esclarecer a população sobre a importância da vitamina. Os achados mostram ser necessária a articulação sistemática entre esferas de governo para que o programa seja executado e monitorado em sua plenitude.

The importance of β-carotene as a source of vitamin A with special regard to pregnant and breastfeeding women

Vitamin A is essential for growth and differentiation of a number of cells and tissues. Notably during pregnancy and throughout the breastfeeding period, vitamin A has an important role in the healthy development of the fetus and the newborn, with lung development and maturation being particularly important. The German Nutrition Society (DGE) recommends a 40% increase in vitamin A intake for pregnant women and a 90% increase for breastfeeding women. However, pregnant women or those considering becoming pregnant are generally advised to avoid the intake of vitamin A rich liver and liver foods, based upon unsupported scientific findings. As a result, the provitamin A carotenoid beta-carotene remains their essential source of vitamin A. Basic sources of provitamin A are orange and dark green vegetables, followed by fortified beverages which represent between 20% and 40% of the daily supply. The average intake of beta-carotene in Germany is about 1.5-2 mg a day. Assuming a vitamin A conversion rate for beta-carotene for juices of 4:1, and fruit and vegetables between 12:1 and 26:1; the total vitamin A contribution from beta-carotene intake represents 10-15% of the RDA. The American Pediatrics Association cites vitamin A as one of the most critical vitamins during pregnancy and the breastfeeding period, especially in terms of lung function and maturation. If the vitamin A supply of the mother is inadequate, her supply to the fetus will also be inadequate, as will later be her milk. These inadequacies cannot be compensated by postnatal supplementation. A clinical study in pregnant women with short birth intervals or multiple births showed that almost 1/3 of the women had plasma retinol levels below 1.4 micromol/l corresponding to a borderline deficiency. Despite the fact that vitamin A and beta-carotene rich food is generally available, risk groups for low vitamin A supply exist in the western world. It is therefore highly critical to restrict the beta-carotene supply from diet, particularly from sources of beta-carotene with high consumer acceptance such as fortified juices (e.g. "ACE juices") or dietary supplements (e.g. multivitamins for pregnant women). For the part of the population unable to meet vitamin A requirements according to the DACH recommendations, sufficient intake of beta-carotene may be crucial to help improve and maintain adequate vitamin A status and prevention of developmental disorders. At this time it has to be urgently advised against restricting the beta-carotene supply or putting warning labels on beta-carotene fortified products. It is, however, highly recommended to improve the available data on nutrient intakes in Germany, especially for pregnant and breastfeeding women. For them, recommendations to be aware of potential nutrient intake inadequacies might prove useful.

Systemic levels of carotenoids from mangoes and papaya consumed in three forms (juice, fresh and dry slice)

BACKGROUND

Vitamin A deficiency is a public health problem in Cameroon. Data on the bioavailability of carotenoid in fruits currently consumed in Cameroon are scarce.

OBJECTIVE

To assess the systemic levels of carotenoids from mangoes and papaya consumed as juice, fresh or dried slices.

METHODS

Two groups of seven healthy volunteers (24 and 25 years of age; body mass index: 21 and 22 kg/m(2) respectively for subjects fed mango and papaya), were submitted to three types of meal treatments (juice, fresh and dried fruit). On the experiment day, meals served to fasting subjects during breakfast, included bread, yogurt and one of the three forms of fruit. All the treatments lasted only one day during which blood samples were collected three times; during fasting (T(0)), 4 h (T(4)) and 8 h (T(8)) after the test meal. The carotenoids and retinol contents were analysed by high-performance liquid chromatography method.

RESULTS

From the major carotenoids present in papaya and mangoes, lutein, alpha-carotene and beta-carotene were found in considerable amounts. Lycopene and cryptoxanthin that were the major carotenoids in papaya samples appeared in low amounts in the chylomicrons. Significant correlations were observed between these carotenoids (at T(0), T(4) and T(8)). The three forms of consumption contributed to the rise of serum retinol levels. A comparison between the three forms revealed that papaya and mangoes consumed in form of juice or fresh fruit are the best forms because they had higher bioavailability values.

CONCLUSION

Association of these different forms of consumptions could lead to a better availability of these fruits throughout the year and therefore efficiently contribute to improve vitamin A status of the population.

Intakes of retinol and carotenoids and its determining factors in the Red River Delta population of northern Vietnam

OBJECTIVE

To describe the household intakes of retinol and carotenoids and social economic factors determining their intakes.

SUBJECTS

Data on a total of 1001 households (771 in rural areas and 230 in urban areas) were used in the analyses. Interviewed person was household food preparer.

RESULTS

Mean (s.d.) intake of carotenoids was 4178 (3154) microg/capita/day in rural and 4208 (3408) microg/capita/day in urban areas and intake of retinol was 101 (275) microg/capita/day in rural and 201 (470) microg/capita/day in urban areas. Multivariate analyses show that the subjects in households with four or more members consume about 700 microg carotenoids less compared to households with less than three members. Households with a higher expenditure (fourth quartile) consumed about 100 microg retinol/day more than those with a lower expenditure (first quartile).

CONCLUSION

Carotenoids from plant food sources is the main source of vitamin A intake of the population and its main determinants are household expenditure and size of household. Food fortification and dietary diversification with special emphasis on promotion of consumption of animal foods should be key strategies for overcoming vitamin A deficiency in Vietnam.

Impact of mass supplementation of vitamin A

OBJECTIVE

To study the impact of mass supplementation of Vitamin A solution on morbidity due to diarrhea, Acute respiratory infection (ARI) and xerophthalmia.

METHODS

The two rounds of age specific mass distribution of Vitamin A solution were undertaken during January 2000 and December 2000 respectively covering 27,642 (98.7%) and 31,762 (88.0%) children respectively out of total beneficiaries in two round of PPI in Chandigarh. A random sample of 276 children from intervention area and 252 children from control area in the age group of 1-5 yr were followed up on monthly basis for morbidity pattern for a period of nine mth. The morbidity pattern for intervention and control area children was compared to see the impact of mass supplementation of Vitamin A solution.

RESULTS

The average annual episodes of diarrhea in intervention children were lower (3.9 per yr) as compared to control children (5.2 per yr) although difference was not statistically significant (P>0.05) except in initial month. The average annual episodes of ARI in intervention children were lower (5.1 per yr) as compared to Control children (6.0 per yr) although difference was not significant (P>0.05) except in initial first mth. There was significant decline in vitamin A deficiency (VAD) as no case of Bitot's spot was found in intervention children as compared to control children where the prevalence of Bitot's spot ranged from 4.3-5.08% during different visits. The mortality rate was found to be higher in control children with a death rate of 8 per 1000 children during the study period as compared to intervention children where no death was recorded.

CONCLUSION

It is concluded that mass supplementation of vitamin A led to significant reduction in xerophthalmia and decline in mortality in the intervention area as compared to control area.

Randomized controlled safety and efficacy trial of 2 vitamin A supplementation schedules in Tanzanian infants

BACKGROUND

Vitamin A supplementation reduces morbidity and mortality in children living in areas endemic for vitamin A deficiency. Routine vitamin A supplementation usually starts only at age 9 mo, but high rates of illness and mortality are seen in the first months of life.

OBJECTIVE

The objective of the study was to evaluate the safety and efficacy of vitamin A supplementation at the same time as routine vaccination in infants aged 1-3 mo.

DESIGN

We recruited 780 newborn infants and their mothers to a randomized double-blind controlled trial in Ifakara in southern Tanzania. In one group, mothers received 60,000 microg vitamin A palmitate shortly after delivery, and their infants received 7500 microg at the same time as vaccinations given at approximately 1, 2, and 3 mo of age. In the other group, mothers received a second 60,000-microg dose when their infant was aged 1 mo, and their infants received 15,000 microg at the same time as the routine vaccinations. VAD was defined as a modified relative dose-response test result of >or=0.060.

RESULTS

High-dose vitamin A supplementation was well tolerated. The relative risk of VAD at 6 mo in the high-dose group compared with the lower dose group was 0.91 (95% CI: 0.76, 1.09; P=0.32). Serum retinol and incidence of illness did not differ significantly between the 2 groups. Some vitamin A capsules degraded toward the end of the study.

CONCLUSIONS

Doubling the doses of vitamin A to mothers and their young infants is safe but unlikely to reduce short-term morbidity or to substantially enhance the biochemical vitamin A status of infants at age 6 mo. The stability of vitamin A capsules merits further investigation.

Neonatal-age treatment with vitamin A delays postweaning vitamin A deficiency and increases the antibody response to T-cell dependent antigens in young adult rats fed a vitamin A-deficient diet

Vitamin A supplementation for infants and young children is recommended by WHO/UNICEF for countries with a high prevalence of vitamin A deficiency, and vitamin A is often administered at immunization contacts. Using a rat model, we tested whether supplementation with vitamin A or other retinoids at the time of neonatal immunization has prospective benefit in terms of preventing postweaning vitamin A deficiency and promoting antibody responses to T-cell dependent (TD) antigens administered at the neonatal stage and at the young adult stage. Rats were treated orally on postnatal d 6-8 with oil (placebo control), vitamin A, retinoic acid, or a combination of both (VARA) (n > or = 12/group), and immunized with tetanus toxoid (TT) on d 7. The primary anti-TT response was measured on d 21, after which weanling rats were fed the vitamin A-deficient diet until approximately 10 wk. At 8 wk, rats were immunized again with TT to determine the recall response, and with a novel TD antigen, keyhole limpet hemocyanin (KLH), to assess the adult primary response. None of the supplements affected the plasma titer of anti-TT immunoglobulin G (IgG) on d 21 (P = 0.25). However, neonatal-age supplementation with vitamin A or VARA at the young adult stage resulted in: >5 times higher anti-TT IgG recall response (P < 0.01); 5- and 9-times higher anti-KLH primary IgM and IgG responses, respectively (P < 0.05), and plasma retinol in the normal range (approximately 1.0 micromol/L vs. approximately 0.35 micromol/L in retinoic acid-treated and control groups, P < 0.0001). We conclude that early-life supplementation with vitamin A or VARA can prospectively benefit the primary and recall antibody responses to TD antigens administered at the young adult stage, which may involve the maintenance of normal plasma retinol levels.

Carotene-rich plant foods ingested with minimal dietary fat enhance the total-body vitamin A pool size in Filipino schoolchildren as assessed by stable-isotope-dilution methodology

BACKGROUND

Strategies for improving the vitamin A status of vulnerable populations are needed.

OBJECTIVE

We studied the influence of the amounts of dietary fat on the effectiveness of carotene-rich plant foods in improving vitamin A status.

DESIGN

Schoolchildren aged 9-12 y were fed standardized meals 3 times/d, 5 d/wk, for 9 wk. The meals provided 4.2 mg provitamin A carotenoids/d (mainly beta-carotene) from yellow and green leafy vegetables [carrots, pechay (bok choy), squash, and kangkong (swamp cabbage)] and 7, 15, or 29 g fat/d (2.4, 5, or 10 g fat/meal) in groups A, B, and C (n = 39, 39, and 38, respectively). Other self-selected foods eaten were recorded daily. Before and after the intervention, total-body vitamin A pool sizes and liver vitamin A concentrations were measured with the deuterated-retinol-dilution method; serum retinol and carotenoid concentrations were measured by HPLC.

RESULTS

Similar increases in mean serum beta-carotene (5-fold), alpha-carotene (19-fold), and beta-cryptoxanthin (2-fold) concentrations; total-body vitamin A pool size (2-fold); and liver vitamin A (2-fold) concentrations were observed after 9 wk in the 3 study groups; mean serum retinol concentrations did not change significantly. The total daily beta-carotene intake from study meals plus self-selected foods was similar between the 3 groups and was 14 times the usual intake; total fat intake was 0.9, 1.4, or 2.0 times the usual intake in groups A, B, and C, respectively. The overall prevalence of low liver vitamin A (<0.07 mumol/g) decreased from 35% to 7%.

CONCLUSIONS

Carotene-rich yellow and green leafy vegetables, when ingested with minimal fat, enhance serum carotenoids and the total-body vitamin A pool size and can restore low liver vitamin A concentrations to normal concentrations.

Community-level micronutrient fortification of a food supplement in India: a controlled trial in preschool children aged 36-66 mo

BACKGROUND

Children participating in the Integrated Child Development Service (ICDS) in India have high rates of iron and vitamin A deficiency.

OBJECTIVE

The objective was to assess the efficacy of a premix fortified with iron and vitamin A and added at the community level to prepared khichdi, a rice and dal mixture, in increasing iron and vitamin A stores and decreasing the prevalence of iron deficiency, anemia, and vitamin A deficiency.

DESIGN

This cluster, randomized, double-blind, controlled trial was initiated in 30 Anganwadi centers (daycare centers) in West Bengal state, India. Children aged 36-66 mo (n = 516) attending village-based ICDS centers were randomly assigned to receive either a fortified or a nonfortified premix for 24 wk. Blood was drawn at 0 and 24 wk by venipuncture for the measurement of hemoglobin, serum ferritin, and serum retinol.

RESULTS

The change in the hemoglobin concentration of anemic children was significantly different between fortified and nonfortified khichdi groups (P < 0.001). Prevalence rates of anemia, iron deficiency, and iron deficiency anemia were significantly lower after 24 wk in the fortified-khichdi group than in the nonfortified-khichdi group (P < 0.001). There were no significant differences in serum retinol concentrations or in the prevalence of vitamin A deficiency between the fortified- and nonfortified-khichdi groups.

CONCLUSION

A premix fortified with iron, vitamin A, and folic acid and added to supplementary food at the community level can be effective at increasing iron stores and reducing the prevalence of iron deficiency and anemia.

[Survey on the status of dietary vitamin a intakes in Chinese residents]

OBJECTIVE

To describe the intake status of dietary vitamin A and the trends of the intakes from 1982 to 2002 in Chinese residents.

METHODS

This paper was based on the data collected in "the Nutrition and Health Status of the Chinese People in 2002". The subjects in the dietary survey were 68 965 residents from 23 470 households.

RESULTS

The average retinol equivalent intake in per day was 469.2 microg for per reference man. The residents with the retinol equivalent intake equal or higher than RNI accounted for 14.5% and those with the intake lower than 20% of the RNI accounted for 23.2%. The retinol equivalent intake in type III rural areas was the lowest among all the areas with only 9.7% residents having intakes equal or higher than RNI. The intakes of the retinol equivalent increased with the mounting of income level. The average retinol equivalent intake was not seen improved during the past twenty years.

CONCLUSION

The dietary intake of vitamin A could be lower in Chinese residents.

Analysis of Failure Time Data with Multilevel Clustering, with Application to the Child Vitamin A Intervention Trial in Nepal

We consider the problem of estimating covariate effects in the marginal Cox proportional hazard model and multilevel associations for child mortality data collected from a vitamin A supplementation trial in Nepal, where the data are clustered within households and villages. For this purpose, a class of multivariate survival models that can be represented by a functional of marginal survival functions and accounts for hierarchical structure of clustering is exploited. Based on this class of models, an estimation strategy involving a within-cluster resampling procedure is proposed, and a model assessment approach is presented. The asymptotic theory for the proposed estimators and lack-of-fit test is established. The simulation study shows that the estimates are approximately unbiased, and the proposed test statistic is conservative under extremely heavy censoring but approaches the size otherwise. The analysis of the Nepal study data shows that the association of mortality is much greater within households than within villages.

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

OBJECTIVE

To 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.

DESIGN

A parallel design (no control area) was used to assess changes in VA intake and serum retinol over a 15-week period.

SETTING AND SUBJECTS

A 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).

RESULTS

The intervention significantly increased (P < 0.001) total VA intake by 56% in PA$$ and by 50% in PA. VA intake from liver increased significantly (P < 0.001) from 12.7 +/- 23.5 to 155.3 +/- 56.3 microg retinol activity equivalents (RAE) in PA$$ and from 21.6 +/- 29.7 to 135.3 +/- 44.9 microg 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 micromol l(-1) in PA$$ vs. 0.17 micromol l(-1) and in PA) did not differ significantly (P = 0.455) between groups over the intervention.

CONCLUSION

Promotional 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.

Factors to consider in Micronesian food-based interventions: a case study of preventing vitamin A deficiency

Background:

Many factors need to be considered in a food-based intervention. Vitamin A deficiency and chronic diseases, such as diabetes, heart disease and cancer, have become serious problems in the Federated States of Micronesia (FSM) following the decreased production and consumption of locally grown foods. However, agricultural and social conditions are still favourable for local food production.

Aim:

To identify key factors to consider in a Micronesian food-based intervention focusing on increased production and consumption of four major Micronesian staple foods: banana, breadfruit, giant swamp taro and pandanus.

Methods:

Ethnographic methods including key informant interviews and a literature review.

Results:

Pacific and Micronesian values, concepts of food and disease, and food classifications differ sharply from Western concepts. There are few FSM professionals with nutrition expertise. Traditional foods and food cultivars vary in nutrient content, consumption level, cost, availability, status, convenience in growing, storing and cooking, and organoleptic factors.

Conclusions:

A systematic consideration of the factors that relate to a food-based intervention is critical to its success. The evaluation of which food and cultivar of that food that might be most effectively promoted is also critical. Regional differences, for example FSM inter-island differences between the staple foods and cultivars, must be considered carefully. The evaluation framework presented here may be relevant to Pacific Island and other countries with similar foods where food-based interventions are being planned. An ethnographic approach was found to be essential in understanding the cultural context and in data collection and analysis.

Stable isotope dilution techniques for assessing vitamin A status and bioefficacy of provitamin A carotenoids in humans

Vitamin A deficiency is a major global public health problem. Among the variety of techniques that are available for assessing human vitamin A status, evaluating the provitamin A nutritional values of foodstuffs and estimating human vitamin A requirements, isotope dilution provides the most accurate estimates. Although the relative expense of isotope dilution restricts its applications, it has an important function as the standard of reference for other techniques. Mathematical modelling plays an indispensable role in the interpretation of isotope dilution data. This review summarises recent applications of stable isotope methodology to determine human vitamin A status, estimate human vitamin A requirements, and calculate the bioconversion and bioefficacy of food carotenoids.

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

Objective:

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−1decreased 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

Carotenoid content of pandanus fruit cultivars and other foods of the Republic of Kiribati

Background

Kiribati, a remote atoll island country of the Pacific, has serious problems of vitamin A deficiency (VAD). Thus, it is important to identify locally grown acceptable foods that might be promoted to alleviate this problem. Pandanus fruit (Pandanus tectorius) is a well-liked indigenous Kiribati food with many cultivars that have orange/yellow flesh, indicative of carotenoid content. Few have been previously analysed.

Aim

This study was conducted to identify cultivars of pandanus and other foods that could be promoted to alleviate VAD in Kiribati.

Method

Ethnography was used to select foods and assess acceptability factors. Pandanus and other foods were analysed for β- and α-carotene, β-cryptoxanthin, lutein, zeaxanthin, lycopene and total carotenoids using high-performance liquid chromatography.

Results

Of the nine pandanus cultivars investigated there was a great range of provitamin A carotenoid levels (from 62 to 19 086 μg β-carotene/100 g), generally with higher levels in those more deeply coloured. Seven pandanus cultivars, one giant swamp taro (Cyrtosperma chamissonis) cultivar and native fig (Ficus tinctoria) had significant provitamin A carotenoid content, meeting all or half of estimated daily vitamin A requirements within normal consumption patterns. Analyses in different laboratories confirmed high carotenoid levels in pandanus but showed that there are still questions as to how high the levels might be, owing to variation arising from different handling/preparation/analytical techniques.

Conclusions

These carotenoid-rich acceptable foods should be promoted for alleviating VAD in Kiribati and possibly other Pacific contexts where these foods are important. Further research in the Pacific is needed to identify additional indigenous foods with potential health benefits.

Impact of vitamin A supplementation on health status and absenteeism of school children in Sri Lanka

The objective of this study was to determine the impact of Vitamin A supplementation on health status and absenteeism of school children. A randomized double blind placebo controlled trial over a period of 13 months was conducted in a rural area of Sri Lanka involving 613 school children attending Grades 1-5 (aged 5 to 13 years). Children were assigned to either 200,000 IU of Vitamin A (n=297) or placebo (n=316) once every 4 months. Socio-demographic data were obtained at baseline, and anthropometry and haemoglobin concentrations were assessed at baseline and post intervention. Serum vitamin A concentrations were assayed by HPLC in a subgroup of children (n=193) before administration of each dose. School absenteeism was recorded. The two groups of children were similar at baseline in all variables. The subgroup of children was comparable to the main study population. The prevalence of vitamin A deficiency (< 20 microg/dL) in the subgroup of children was 8.2%. Changes in anthropometric indices and haemoglobin concentrations were similar in the two groups. The major causes for absenteeism were non-health causes and supplemented children lost a fewer number of school days due to illness than placebo children (p=0.053). Vitamin A concentrations improved with each dose and the improvement was greater with better compliance. Vitamin A supplementation with 200,000 IU every 4 months over 13 months improved vitamin A status and school attendance but not anthropometric status of these children.

Vitamin A supplementation and retinoic acid treatment in the regulation of antibody responses in vivo

Vitamin A (VA, retinol) is essential for normal immune system maturation, but the effect of VA(1) on antibody production, the hallmark of successful vaccination, is still not well understood. In countries where VA deficiency is a public health problem, many children worldwide are now receiving VA along with immunizations against poliovirus, measles, diphtheria, pertussis, and tetanus. The primary goal has been to provide enough VA to protect against the development of VA deficiency for a period of 4-6 months. However, it is also possible that VA might promote the vaccine antibody response. Several community studies, generally of small size, have been conducted in children supplemented with VA at the time of immunization, as promoted by the World Health Organization/UNICEF. However, only a few studies have reported differences in antibody titers or seroconversion rates due to VA. However, VA status was not directly assessed, and in some communities children were often breast fed, another strategy for preventing VA deficiency. Some of the vaccines used induced a high rate of seroconversion, even without VA. In children likely to have been VA deficient, oral polio vaccine seroconversion rate was increased by VA. In animal models, where VA status was controlled and VA deficiency confirmed, the antibody response to T-cell-dependent (TD) and polysaccharide antigens was significantly reduced, congruent with other defects in innate and adaptive immunity. Moreover, the active metabolite of VA, retinoic acid (RA) can potentiate antibody production to TD antigens in normal adult and neonatal animals. We speculate that numerous animal studies have correctly identified VA deficiency as a risk factor for low antibody production. A lack of effect of VA in human studies could be due to a low rate of VA deficiency in the populations studied or low sample numbers. The ability to detect differences in antibody response may also depend on the vaccine-adjuvant combination used. Future studies of VA supplementation and immunization should include assessment of VA status and a sufficiently large sample size. It would also be worthwhile to test the effect of neonatal VA supplementation on the response to immunization given after 6 months to 1 year of age, as VA supplementation, by preventing the onset of VA deficiency, may improve the response to immunizations given later on.

Caregiver knowledge, attitudes and practices regarding vitamin A intake by Dominican children

Vitamin A deficiency (VAD) is a major concern in the Dominican Republic. Successful educational interventions are based on needs assessment data specific to the population for which behavioural change is desired. The purpose of this study was to establish a foundation for nutrition education efforts for caregivers of young children to prevent VAD in the Dominican Republic. A cross-sectional survey was administered to caregivers (N = 151) from rural/peri-urban villages in five provinces to assess vitamin A knowledge and attitudes, frequency of consumption of foods rich in vitamin A by an index child (age range 3-9 years), and food-related practices contributing to vitamin A intake. Caregiver knowledge regarding vitamin A was low in all villages regardless of differences in socio-economic status and level of education. A majority of the caregivers (67%) reported having a garden, but produce from the garden was thought mainly to provide a financial benefit vs. a nutritional benefit for the family. Several vegetables rich in vitamin A used as seasoning, mango, and unripe banana and plantain were commonly consumed by children as reported by caregivers. Educational interventions should focus on basic vitamin A knowledge regarding sources as well as symptoms of deficiency. Education should also emphasize increasing the variety of foods rich in provitamin A carotenoids grown in home gardens.

Carotenoid Content and Flesh Color of Selected Banana Cultivars Growing in Australia

Background

The problems of vitamin A deficiency and chronic diseases have emerged in recent years in some countries in the Micronesian region. These problems are associated with the dietary shift towards imported processed foods and lifestyle changes. Research in the Federated States of Micronesia indicates that yellow- and orange-fleshed banana cultivars contain significant levels of provitamin A carotenoids.

Objective

To identify further banana cultivars that may be promoted to alleviate vitamin A deficiency among children and women and chronic disease problems among adults.

Methods

Ripe fruit of banana cultivars growing in Australia (sourced mostly from a field research collection) were assessed for carotenoid content and flesh color. Ten cultivars with yellow or yellow/orange flesh color (including common cultivars of Southeast Asia and the Pacific Islands) were selected and compared with two cream-fleshed cultivars, including Williams, of the Cavendish group, the most commonly marketed banana worldwide. Carotenoid content was analyzed by high-performance liquid chromatography (HPLC). Flesh color was analyzed by HunterLab colorimetry.

Results

The yellow/orange-fleshed Asupina (a Fe'i banana) contained the highest level (1,412 μg/100 g) of trans β-carotene, the most important provitamin A carotenoid, a level more than 20 times higher than that of Williams. All 10 yellow or yellow/orange-fleshed cultivars ( Asupina, Kirkirnan, Pisang Raja, Horn Plantain, Pacific Plantain, Kluai Khai Bonng, Wain, Red Dacca, Lakatan, and Sucrier) had significant carotenoid levels, potentially meeting half or all of the estimated vitamin A requirements for a nonpregnant, nonlactating adult woman within normal consumption patterns. All were acceptable for taste and other attributes. The cream-fleshed cultivars had minimal carotenoid levels. There was a positive significant correlation between carotenoid content and deeper yellow/orange coloration indicators.

Conclusions

These yellow- or yellow/orange-fleshed carotenoid-rich banana cultivars should be considered for promotion in order to alleviate vitamin A deficiency and chronic disease in susceptible target communities and to provide variety and enjoyment as exotic fruits in both developing and industrialized countries.