Seasonal variation in signs of vitamin-A deficiency in rural West Bengal children

Geographical and sociodemographic disparities in fruit and vegetables consumption among adults in Burkina Faso: baseline results from the 2013 WHO STEPS survey

BACKGROUND

Evidence on sociodemographic determinants and spatial variations in the fruit and/or vegetable (FV) consumption was reported. This study aimed to explore geographical and sociodemographic disparities in the level of FV consumption among adults in Burkina Faso, using the national baseline data.

METHODS

This was a cross-sectional secondary study of primary data obtained by the 2013 (September to October) World Health Organization Stepwise Approach to Surveillance survey conducted in Burkina Faso. The participants were 4402 women and men aged 25-64 years and living in all 13 Burkinabè Regions. Descriptive and analytical analyses were performed using Student's t test, ANOVA, the chi-square test, Fisher's exact test and logistic regressions.

RESULTS

The prevalence of a typical daily consumption of at least three servings was 4.1% (95% CI: 3.6-4.8) for fruits and 6.6% (95% CI: 5.9-7.3) for vegetables. The national prevalence of adequate FV intake was 5.1% (95% CI: 4.4-5.8), and for two Regions ("Centre-Ouest" and "Nord") the pooled prevalence was 22.4%, while in the other eleven Regions its was significantly lower, 2.4% (p = 0.0001). Using quartiles derived from the national level of consumption, each of these two Regions had a higher proportion (about 50%) of their participants in the fourth quartile (the higher level). The associated sociodemographic factors with the adequate intake were being rural residents (aOR = 1.7, p = 0.011) and women (aOR = 1.3; p = 0.03).

CONCLUSION

Except for the Regions of "Centre-Ouest" and "Nord" of Burkina Faso, the prevalence of adequate consumption of FV was very low in its other eleven Regions. Measures to increase consumption in urban people are urgent while women should be the key actor in the family-based approaches implementation and the nutrition education promoting FV consumption.

Carotenoid metabolism at the intestinal barrier

Carotenoids exert a rich variety of physiological functions in mammals and are beneficial for human health. These lipids are acquired from the diet and metabolized to apocarotenoids, including retinoids (vitamin A and its metabolites). The small intestine is a major site for their absorption and bioconversion. From here, carotenoids and their metabolites are distributed within the body in triacylglycerol-rich lipoproteins to support retinoid signaling in peripheral tissues and photoreceptor function in the eyes. In recent years, much progress has been made in identifying carotenoid metabolizing enzymes, transporters, and binding proteins. A diet-responsive regulatory network controls the activity of these components and adapts carotenoid absorption and bioconversion to the bodily requirements of these lipids. Genetic variability in the genes encoding these components alters carotenoid homeostasis and is associated with pathologies. We here summarize the advanced state of knowledge about intestinal carotenoid metabolism and its impact on carotenoid and retinoid homeostasis of other organ systems, including the eyes, liver, and immune system. The implication of the findings for science-based intake recommendations for these essential dietary lipids is discussed. This article is part of a Special Issue entitled Carotenoids recent advances in cell and molecular biology edited by Johannes von Lintig and Loredana Quadro.

To see, hear, and live: 25 years of the vitamin A programme in Nepal

Nepal has a rich history of vitamin A research and a national, biannual preschool vitamin A supplementation (VAS) programme that has sustained high coverage for 25 years despite many challenges, including conflict. Key elements of programme success have included (a) evidence of a 26–30% reduction in child mortality from two, in‐country randomized trials; (b) strong political and donor support; (c) positioning local female community health volunteers as key operatives; (d) nationwide community mobilization and demand creation for the programme; and (e) gradual expansion of the programme over a period of several years, conducting and integrating delivery research, and monitoring to allow new approaches to be tested and adapted to available resources. The VAS network has served as a platform for delivering other services, including anthelmintic treatment and screening for acute malnutrition. We estimate that VAS has saved over 45,000 young lives over the past 15 years of attained national coverage. Consumption of vitamin A‐ and carotenoid‐rich foods by children and women nationally remains low, indicating that supplementation is still needed. Current challenges and opportunities to improving vitamin A status include lower VAS coverage among younger children (infants 6–11 months of age), finding ways to increase availability and access to dietary vitamin A sources, and ensuring local programme investments given the recent decentralization of the government.

Magnitude and Distribution of Vitamin A Deficiency in Ethiopia

Background

Several surveys conducted over a period of 40 years have shown that vitamin A deficiency is a serious public health problem in Ethiopia. To address the problem effectively, up-to-date, comprehensive information on the magnitude and distribution of vitamin A deficiency is needed.

Objective

A national vitamin A survey was conducted to assess the national and regional prevalence rates of vitamin A deficiency in Ethiopia.

Methods

The survey employed a multistage, cluster-sampling approach and a cross-sectional study design. A total of 23,148 children aged 6 to 71 months and their respective mothers were examined for clinical signs and symptoms, and blood samples were collected from 1,200 systematically selected children for serum retinol analysis.

Results

The findings indicated national prevalence rates of 1.7% for Bitot's spots among children. 0.8% for night-blindness among children, and 1.8% for night-blindness among mothers. Nationally, 37.7% of children (95% CI, 35.6% to 39.9%) had deficient serum retinol levels, 50.7% had been sick in the previous 15 days, and 22.6% had received vitamin A supplements in the previous 6 months. The prevalence of clinical vitamin A deficiency was significantly (p < .05) higher among children who were male, older, or rural residents.

Conclusions

The study confirmed that vitamin A deficiency is a serious public health problem in Ethiopia. Intensification of the ongoing vitamin A supplementation program, postpartum vitamin A supplementation for mothers, intensifying efforts to improve the health status of preschool age children, and promotion of production and consumption of fruits and vegetables are recommended.

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.

The positive impact of red palm oil in school meals on vitamin A status: study in Burkina Faso

Background

Vitamin A (VA) deficiency is widespread in sub-Saharan Africa and school-age children are a vulnerable group. In Burkina Faso, the production and consumption of red palm oil (RPO) is being promoted as a food supplement for VA. The objective of the study was to assess the impact on serum retinol of adding RPO to school lunch in two test zones of Burkina Faso.

Methods

Over one school year, 15 ml RPO was added to individual meals 3 times a week in selected primary schools in two sites. Serum retinol was measured with HPLC at baseline and exactly 12 months later to take account of seasonality. A simple pre-post test design was used in the Kaya area (north-central Burkina), where 239 pupils from 15 intervention schools were randomly selected for the evaluation. In Bogandé (eastern Burkina), 24 schools were randomised for the controlled intervention trial: 8 negative controls (G1) with only the regular school lunch; 8 positive controls (G2) where the pupils received a single VA capsule (60 mg) at the end of the school year; and 8 schools with RPO through the school year (G3). A random sample of 128 pupils in each school group took part in the evaluation.

Results

In Kaya, serum retinol went from 0.77 ± 0.37 μmol/L at baseline to 1.07 ± 0.40 μmol/L one year later (p < 0.001). The rate of low serum retinol (<0.7 μmol/L) declined from 47.2% to 13.1%. In Bogandé, serum retinol increased significantly (p < 0.001) only in the capsule and RPO groups, going from 0.77 ± 0.28 to 0.98 ± 0.33 μmol/L in the former, and from 0.82 ± 0.3 to 0.98 ± 0.33 μmol/L in the latter. The rate of low serum retinol went from 46.1 to 17.1% in the VA capsule group and from 40.4% to 14.9% in the RPO group. VA-deficient children benefited the most from the capsule or RPO. Female sex, age and height-for-age were positively associated with the response to VA capsules or RPO.

Conclusion

RPO given regularly in small amounts appears highly effective in the reduction of VA deficiency. RPO deserves more attention as a food supplement for VA and as a potential source of rural income in Sahelian countries.

Breast feeding and vitamin A deficiency among children attending a diarrhoea treatment centre in Bangladesh: a case-control study

OBJECTIVE

To determine the effect of breast feeding on the risk of xerophthalmia in children aged 6 months to 3 years attending a diarrhoea treatment centre in Bangladesh.

DESIGN

Case-control study based on stratified analysis (Mantel-Haenszel) and multivariate analysis (logistic regression) of data from a treatment centre based surveillance system.

SETTING

A large diarrhoea treatment centre in Dhaka, Bangladesh.

PATIENTS

2687 children aged 6 months to 3 years representing a 4% systematic sample of all children in this age group treated yearly at the centre over three consecutive years. 66 of the children were cases of xerophthalmia (that is, they had Bitot's spots or corneal lesions or night blindness or night blindness plus conjunctival xerosis or any combination of these) and the remaining 2621 did not have signs or symptoms of vitamin A deficiency. This second group served as controls.

MAIN OUTCOME MEASURE

Xerophthalmia and breast fed at onset of diarrhoea or presentation.

RESULTS

The odds ratio relating breast feeding to vitamin A deficiency after adjustment for a large number of confounding variables (0.26 (95% confidence interval 0.14 to 0.49); p less than 0.001) reflected a 74% reduction in the risk of vitamin A deficiency among breast fed children. The estimated reduction of risk did not decline with age, and some 49% of children aged 24-35 months were still being breast fed. The odds ratio relating breast feeding to xerophthalmia in the third year of life (0.35 (95% confidence interval 0.35 to 0.86) reflected a 65% reduced risk of vitamin A deficiency. Other important risk factors or prognostic indicators for xerophthalmia as identified by multivariate analysis were recent measles, prolonged diarrhoea, severe protein energy malnutrition, and poor socioeconomic state.

CONCLUSIONS

These results indicate that breast feeding was associated with a substantial reduction of the risk of vitamin A deficiency extending to the third year of life and support the recommendation that mothers in developing countries should be advised to breast feed for as long as possible.

Incidence, prevalence, and scale of blinding malnutrition

4595 pre-school-age children in six villages of West Java were examined every 3 months. The incidence of active corneal xerophthalmia was 5 per 1000 per year (95% confidence limits, 2.6-7.5), and the average prevalence during each round of examinations was 12 per 10000. In a randomised, multistage cluster survey of 27084 rural children throughout Indonesia the population-weighted prevalence of active corneal disease among pre-school-age children was 6.4 per 10000 (95% confidence limits 3.2-9.6), 53% of that in the longitudinal study areas. At an adjusted incidence rate of 2.7 per 1000 per year, over 60000 Indonesian children become xerophthalmic every year. By extrapolation of these findings about 500000 new cases of xerophthalmia, half of which lead to blindness, occur each year in India, Bangladesh, the Philippines, and Indonesia combined.

Albumin, transferrin and the thyroxine-binding prealbumin/retinol-binding protein (TBPA-RBP) complex in assessment of malnutrition

A comparative study of the level of 4 plasma proteins in malnutrition shows that albumin has low sensitivity, transferrin has intermediate and the TBPA-RBP complex has the highes sensitivity to an alteration in the nutritional status. According to protein and/or iron deficiency, the synthesis of trnasferrin seems to be submitted to contradictory impulses which partially invalidates this test as a reliable index for estimating protein depletion alone. On the contrary, the components of the TBPA-RBP complex respond together and in a parallel direction to protein deficiency. The high degree of sensitivity of TBPA and RBP to an inadequate protein intake is apparently related to their rapid turnover rate and to their unusual richness in tryptophan, which is known to play a key role in the control of protein synthesis. Measurement of TBPA (or RBP) is proposed as a method for the detection of pre-kwashiorkor and early marasmus.