Efficacy of massive oral doses of retinyl palmitate and mango (Mangifera indica L.) consumption to correct an existing vitamin A deficiency in Senegalese children

The globalization of traditional medicine in northern peru: from shamanism to molecules

Northern Peru represents the center of the Andean "health axis," with roots going back to traditional practices of Cupisnique culture (1000 BC). For more than a decade of research, semistructured interviews were conducted with healers, collectors, and sellers of medicinal plants. In addition, bioassays were carried out to evaluate the efficacy and toxicity of plants found. Most of the 510 species encountered were native to Peru (83%). Fifty percent of the plants used in colonial times have disappeared from the pharmacopoeia. Market vendors specialized either on common and exotic plants, plants for common ailments, and plants only used by healers or on plants with magical purposes. Over 974 preparations with up to 29 different ingredients were used to treat 164 health conditions. Almost 65% of the medicinal plants were applied in these mixtures. Antibacterial activity was confirmed in most plants used for infections. Twenty-four percent of the aqueous extracts and 76% of the ethanolic extracts showed toxicity. Traditional preparation methods take this into account when choosing the appropriate solvent for the preparation of a remedy. The increasing demand for medicinal species did not increase the cultivation of medicinal plants. Most species are wild collected, causing doubts about the sustainability of trade.

Impact of the stage of ripening and dietary fat on in vitro bioaccessibility of beta-carotene in 'Ataulfo' mango

Pulp from "slightly ripe", "moderately ripe", or "fully ripe" mangoes was digested in vitro in the absence and presence of processed chicken as a source of exogenous fat and protein to examine the impact of stage of ripening of mango on micellarization during digestion and intestinal cell uptake (i.e., bioaccessibility) of beta-carotene. The quantity of beta-carotene transferred to the micelle fraction during simulated digestion significantly increased as the fruit ripened and when chicken was mixed with mango before digestion. Qualitative and quantitative changes that occur in pectin from mango pulp during the ripening process influenced the efficiency of micellarization of beta-carotene. Finally, the uptake of beta-carotene in micelles generated during simulated digestion by Caco-2 human intestinal cells confirmed the bioaccessibility of the provitamin A carotenoid in mango.

Extraction and chromatography of carotenoids from pumpkin

Vitamin A deficiency is a health problem in Southeast Asia that can be corrected by feeding orange fruits and vegetables such as mango. Pumpkin is a traditional Korean food that is easy to store and is already believed to have health benefits. We extracted carotenoids from pumpkin by liquid-liquid extraction and by supercritical fluid extraction. We measured carotenoids by reversed-phase chromatography with diode array detection. The major carotenoid in pumpkin (> 80%) is beta-carotene, with lesser amounts of lutein, lycopene, alpha-carotene and cis-beta-carotene. Pumpkin is a rich source of beta-carotene and might be useful for preventing Vitamin A deficiency.

Home gardens focusing on the production of yellow and dark-green leafy vegetables increase the serum retinol concentrations of 2-5-y-old children in South Africa

BACKGROUND

Production of yellow and dark-green leafy vegetables at the household level may provide economically deprived households with direct access to provitamin A-rich foods.

OBJECTIVE

The aim of the study was to determine whether the dietary intake of yellow and dark-green leafy vegetables and the serum retinol concentrations of children improve with a home-gardening program.

DESIGN

A home-gardening program was integrated with a community-based growth-monitoring system in a rural village. Cross-sectional data were collected at baseline and 20 mo after implementation of the program. The dietary intake, serum retinol concentrations, and growth of 2-5-y-old children and maternal knowledge regarding vitamin A were determined. A neighboring village served as a control village.

RESULTS

In the experimental village, 126 home gardens were established, representing approximately one-third of the households. Serum retinol concentrations in the experimental village increased significantly (P = 0.0078), whereas those in the control village decreased significantly (P = 0.0148). At follow-up, children from the experimental village consumed yellow and dark-green leafy vegetables more often and had significantly higher (P = 0.005) serum retinol concentrations (0.81 +/- 0.22 micro mol/L; n = 110) than did children from the control village (0.73 +/- 0.19 micro mol/L; n = 111). Maternal knowledge regarding vitamin A improved significantly in the experimental village (P = 0.001).

CONCLUSION

A home-gardening program that was integrated with a primary health care activity, linked to nutrition education, and focused on the production of yellow and dark-green leafy vegetables significantly improved the vitamin A status of 2-5-y-old children in a rural village in South Africa.

Physiologic indicators of vitamin A status

Physiologic indicators reflect the functional consequences of vitamin A deficiency and may be particularly useful for detecting early perturbations in vitamin A status. In conjunctival impression cytology (CIC), epithelial morphology and the presence or absence of mucin spots and goblet cells allow samples, obtained by applying filter paper to the temporal conjunctiva, to be characterized as normal or typical of vitamin A-deficient keratinizing metaplasia. The validity of CIC has been established with reference to other indicators of vitamin A status, and a prevalence of > or =20% abnormal results has been suggested as indicative of a public health problem. However, interpretation of specimens requires considerable training, and nonresponsiveness to supplementation is a frequent problem, which limits the utility of CIC as a method for evaluating the impact of intervention programs. Several simplified field protocols for dark adaptation have been developed, including one in which dark adaptation is assessed by the responsiveness of the pupil to light. Night blind subjects have consistently shown abnormal results on this test, and a significant response to placebo-controlled dosing has been demonstrated for children and pregnant women. Scores have correlated significantly with serum retinol and relative dose response. Pupillary dark adaptation testing is acceptable to most children as young as 2 y old. Limitations of this technique include a time course for recovery after dosing as long as 4-6 wk, a testing time of 20 min, and the need for 1-3 d of training. Given its low cost, noninvasive nature, and lack of the need to transport samples, pupillary dark adaptation offers advantages over other techniques for assessing a population's vitamin A status.

Plasma beta-carotene and retinol concentrations of children increase after a 30-d supplementation with the fruit Momordica cochinchinensis (gac)

BACKGROUND

In rural Vietnam, vitamin A deficiency is a concern. Among the indigenous fruit and vegetables, Momordica cochinchinensis (gac) fruit has been identified as having the highest beta-carotene concentration. Locally, it is mixed with rice in a preparation called xoi gac.

OBJECTIVE

The purpose of this study was to assess this beta-carotene- rich rice preparation as a source of provitamin A for children in rural Vietnam.

DESIGN

Preschoolers (n = 185) participated in a 30-d controlled supplementation trial. Children with low hemoglobin concentrations were assigned to 1 of 3 groups: a fruit group, who received xoi gac that contained 3.5 mg beta-carotene per serving; a powder group, who received rice mixed with 5.0 mg synthetic beta-carotene powder; and a control group, who received rice without fortification.

RESULTS

The mean increase in plasma beta-carotene concentrations in the fruit and powder groups was significantly greater than that in the control group (P < 0.0001). After supplementation, the mean plasma retinol concentration in the fruit group was significantly higher than that in the control (P = 0.006) and powder (P = 0.0053) groups. Among the children with initial hemoglobin concentrations <or=110 g/L, the mean increase in hemoglobin concentrations in the fruit group was marginally higher than that in the control group (P = 0.017) but was not significantly different from that in the powder group.

CONCLUSIONS

beta-Carotene from xoi gac is a good source of provitamin A carotenoids. Severely anemic children might particularly benefit from routine xoi gac consumption

Increased vitamin A intake in children aged 2-5 years through targeted home-gardens in a rural South African community

OBJECTIVES

To determine vitamin A intake of children aged 2-5 years in a rural South African community one year after the implementation of a home-based food production programme targeting beta-carotene-rich fruits and vegetables.

DESIGN

Dietary intake of children aged 2-5 years was determined during a cross-sectional survey before and one year after the implementation of a home-based food production programme.

SETTING

A low socio-economic rural African community, approximately 60 km northwest of the coastal city of Durban in KwaZulu-Natal, South Africa.

SUBJECTS

Children aged 2-5 years (n = 100); 50 children from households with home-gardens producing beta-carotene fruits and vegetables (project gardens), and 50 children from households without project gardens.

RESULTS

As compared with baseline data, there was a significant increase in vitamin A intake in children from households with project gardens as well as in children from households without project gardens. However, children from households with project gardens had a significantly higher vitamin A intake than children from households without project gardens. The increased vitamin A intake in those children from households without project gardens can be attributed to the availability of butternuts in the local shop (as a result of the project), and because the mothers negotiated with project garden mothers to obtain these fruits and vegetables for their children.

CONCLUSION

A home-based food production programme targeting beta-carotene-rich fruits and vegetables can lead to an increase in vitamin A intake.

Dynamics of conjunctival impression cytologic changes after vitamin A supplementation

To investigate the chronological changes in conjunctival epithelium after supplementation with a massive oral dose of vitamin A, conjunctival impression cytology (CIC) with transfer was carried out repeatedly among 200 children aged 6-120 months in a randomized, double-blind, placebo-controlled study in Chandigarh (India). Significant conversion to normal CIC started 71-80 d after vitamin A supplementation and by 101-110 d conversion had taken place in all children. Compared with the placebo group, plasma retinol concentration at 100 d post-supplement was found to be significantly higher in the vitamin A-supplemented group P = 0.04. This study demonstrates that CIC responds to a massive oral dose of vitamin A 3-4 months after supplementation. These findings should guide future studies and evaluations in which CIC is used to assess response to vitamin A interventions.

Lack of improvement in vitamin A status with increased consumption of dark-green leafy vegetables

There is little evidence to support the general assumption that dietary carotenoids can improve vitamin A status. We investigated in Bogor District, West Java, Indonesia, the effect of an additional daily portion of dark-green leafy vegetables on vitamin A and iron status in women with low haemoglobin concentrations (< 130 g/L) who were breastfeeding a child of 3-17 months. Every day for 12 weeks one group (n = 57) received stir-fried vegetables, a second (n = 62) received a wafer enriched with beta-carotene, iron, vitamin C, and folic acid, and a third (n = 56) received a non-enriched wafer to control for additional energy intake. The vegetable supplement and the enriched wafer contained 3.5 mg beta-carotene, 5.2 mg and 4.8 mg iron, and 7.8 g and 4.4 g fat, respectively. Assignment to vegetable or wafer groups was by village. Wafers were distributed double-masked. In the enriched-wafer group there were increases in serum retinol (mean increase 0.32 [95% CI 0.23-0.40] mumol/L), breastmilk retinol (0.59 [0.35-0.84] mumol/L), and serum beta-carotene (0.73 [0.59-0.88] mumol/L). These changes differed significantly from those in the other two groups, in which the only significant changes were small increases in breastmilk retinol in the control-wafer group (0.16 [0.02-0.30] mumol/L) and in serum beta-carotene in the vegetable group (0.03 [0-0.06] mumol/L). Changes in iron status were similar in all three groups. An additional daily portion of dark-green leafy vegetables did not improve vitamin A status, whereas a similar amount of beta-carotene from a simpler matrix produced a strong improvement. These results suggest that the approach to combating vitamin A deficiency by increases in the consumption of provitamin A carotenoids from vegetables should be re-examined.

A randomised controlled trial to test equivalence between retinyl palmitate and beta carotene for vitamin A deficiency

OBJECTIVES

To determine whether beta carotene is therapeutically equivalent to retinyl palmitate in the formulation currently recommended by the World Health Organisation.

DESIGN

Randomised blind equivalence trial.

SETTING

Rural area in Senegal.

SUBJECTS

Children aged 2-15 years suffering from vitamin A deficiency as defined by abnormal results on eye cytology were randomly allocated treatment with retinyl palmitate (n = 256) and beta carotene (n = 254).

MAIN OUTCOME MEASURE

Reversion to normal results on eye cytology as defined by the reappearance of goblet cells and normalisation of the epithelial cells.

RESULTS

Seven weeks after the supplement was given the percentages were 51.2% (124/242) children taking retinyl palmitate and 50.0% (123/246) of those taking beta carotene, who had reverted to normal eye cytology, a difference of 1.2% (95% confidence interval 6.2% to 8.6%) [corrected]. According to an equivalence testing procedure, the two treatments were statistically equivalent; the null hypothesis of non-equivalence was rejected (one tailed p value = 0.03).

CONCLUSIONS

beta Carotene supplementation seems to be a promising candidate for the alleviation of vitamin A deficiency. It could be given either as high dose capsule or through increased dietary intake. The challenge now is to improve dietary intake of vitamin A in programmes that are effective and sustainable at the community level.