Supplementing lactating women with puréed papaya and grated carrots improved vitamin A status in a placebo-controlled trial

Supplementation of red palm olein-enriched biscuits improves levels of provitamin A carotenes, iron, and erythropoiesis in vitamin A-deficient primary schoolchildren: a double-blinded randomised controlled trial

PURPOSE

Vitamin A deficiency (VAD) remains a significant contributor to childhood morbidity and mortality in developing countries; therefore, the implementation of sustainable and cost-effective approaches to control VAD is of utmost pertinence. This study aims to investigate the efficacy of red palm olein (RPO)-enriched biscuit supplementation in improving vitamin A, haematological, iron, and inflammatory status among vitamin A-deficient schoolchildren.

METHODS

We conducted a double-blinded, randomised controlled trial involving 651 rural primary schoolchildren (8-12 years) with VAD in Malaysia. The schoolchildren were randomised to receive either RPO-enriched biscuits (experimental group, n = 334) or palm olein-enriched biscuits (control group, n = 317) for 6-month duration.

RESULTS

Significant improvements in retinol and retinol-binding protein 4 levels were observed in both groups after supplementation (P < 0.001). The improvement in retinol levels were similar across groups among subjects with confirmed VAD (P = 0.40). Among those with marginal VAD, greater improvement in retinol levels was recorded in the control group (P < 0.001) but lacked clinical significance. The levels of α- and β-carotenes, haematological parameters (haemoglobin, packed cell volume, mean corpuscular volume and mean corpuscular haemoglobin) and iron enhanced more significantly in the experimental group (P < 0.05). The significant reduction in the prevalence of microcytic anaemia (- 21.8%) and high inflammation (- 8.1%) was only observed in the experimental group.

CONCLUSION

The supplementation of RPO-enriched biscuits enhanced levels of provitamin A carotenes, iron, and erythropoiesis, and exhibited anti-inflammatory effects. Therefore, the incorporation of RPO into National Nutritional Intervention Programs may be a potential measure to improve the health status of vitamin A-deficient children, among various other interventions.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov (NCT03256123).

Prevalence of childhood anemia: Potential sociodemographic and dietary factors in Nigeria

BACKGROUND

Childhood anemia is a global public health issue. In this study, we assessed the potential sociodemographic and dietary factors associated with the prevalence of anemia among children aged 6-59 months in Nigeria.

METHODS

In this cross-sectional study, we collected dietary information and demographic data on 6,338 children with anemia from the Nigerian Demographic and Health Surveys (2018). The association between the occurrence of anemia and the demographic and dietary factors was determined by conducting Chi-squared tests. Additionally, bivariate and multivariate order logit models were constructed and reported as odds ratios.

RESULTS

The results of the multivariate analysis showed that the risk of anemia was reduced by 13% and 44% in children aged 13-36 months (OR = 0.87; 95% CI = 0.77-0.98; p = 0.019) and 37-59 months (OR = 0.56; 95% CI = 0.49-0.63; p < 0.001), respectively, compared to the risk of anemia in children aged 6-12 months. Anemia was 28% less likely in children of non-anemic mothers (OR = 0.72; 95% CI = 0.66-0.80; p < 0.001) than children of anemic mothers. Children fed pumpkin, carrot, squash, and sweet potato showed a lower occurrence of anemia by 17% (OR = 0.83; 95% CI = 0.70-0.99; p = 0.036) compared to those who were not fed these vegetables. Chances of anemia increased by 14% in children who were fed white potatoes, white yams, manioc, cassava, and other root-based foods (OR = 1.14; 95% CI = 1.01-1.29; p = 0.036).

CONCLUSION

This study highlighted the impact of a plant-based diet on the high prevalence of childhood anemia in Nigeria. Therefore, reformation of dietary habits, the inclusion of nutritional supplements, and food-fortification programs with reductions in maternal anemia are recommended.

Systematic Review and Meta-Analysis of the Relative Dose-Response Tests to Assess Vitamin A Status

Vitamin A (VA) is an essential nutrient often lacking in the diets of people in developing countries. Accurate biomarkers of VA status are vital to inform public health policy and monitor interventions. The relative dose-response (RDR) and modified-RDR (MRDR) tests are semi-quantitative screening tests for VA deficiency that have been used in Demographic and Health Surveys and VA intervention studies. A systematic review and meta-analysis of sensitivity and specificity were conducted to summarize the physiological evidence to support the RDR tests as methods to assess VA status and investigate the impact of different pathological and physiological states on the tests. A total of 190 studies were screened for inclusion, with 21 studies comparing the RDR tests with the gold-standard biomarker, liver VA concentration (68% and 80% sensitivity and 85% and 69% specificity for the RDR and MRDR, respectively). Nearly all studies with VA interventions in VA-deficient populations demonstrated a response of the tests to VA intake that would be expected to improve VA status. The impacts of chronic liver disease, protein malnutrition, age, pregnancy and lactation, infection and inflammation, and various other conditions were examined in 51 studies. The RDR and MRDR tests were reported to have been used in 39 observational studies, and the MRDR has been used in at least 6 national micronutrient surveys. The RDR and MRDR are sensitive tests for determining population VA status and assessing VA interventions. Although they are robust to most physiological and pathological states, caution may be warranted when using the tests in neonates, individuals with chronic liver disease, and those with protein or iron malnutrition. Research on further improvements to the tests to increase accessibility, such as sampling breast milk instead of blood or using intramuscular doses in subjects with malabsorption, will allow wider adoption. This review was registered with PROSPERO as CRD42019124180.

Vitamin A Requirements in Pregnancy and Lactation

Pregnancy and lactation are critical life stages with unique nutritional requirements, including for vitamin A (VA). Current DRIs for VA were published in 2001. The objective of this review was to identify and categorize evidence related to VA requirements in pregnancy and lactation since these DRIs were formulated. We searched MEDLINE and included articles according to an analytic framework of maternal VA exposure on status and health outcomes in the mother-child dyad. Intermediate and indirect evidence supports that maternal VA intakes can impact the mother's VA status, breastmilk, and health outcomes, as well as the child's VA status and select health outcomes. Food-based approaches can lead to more sustained, sufficient VA status in mothers and children. Research needs include further study linking maternal VA intakes on maternal and child VA status, and further associations with outcomes to determine intake requirements to optimize health.

The role of vitamin A and its pro-vitamin carotenoids in fetal and neonatal programming: gaps in knowledge and metabolic pathways

Vitamin A (VA) and its pro-vitamin carotenoids are naturally occurring lipophilic compounds involved in several cellular processes and metabolic pathways. Despite their broad spectrum of activities in the general population, dietary deficiencies of these compounds can potentially affect pregnancy outcomes. Since maternal nutritional status and diet composition during pregnancy and lactation can have long-lasting effects in offspring until adulthood, this study presents an overview of VA and the role of pro-VA carotenoids during pregnancy and lactation – the nutrition, metabolism, and biological effects in the offspring. The review aimed to discuss the pro-VA carotenoids and VA-associated pathways and summarize the results with reference to gestational disorders, and VA and pro-VA carotenoids as preventive agents. Also, considering that obesity, overweight, and metabolic diseases are major public health concerns worldwide, fetal and neonatal development is discussed, highlighting the physiological role of these molecules in obesity prevention. This review comprehensively summarizes the current data and shows the potential impact of these compounds on nutritional status in pregnancy and lactation.

Guidelines for Biomarker of Food Intake Reviews (BFIRev): how to conduct an extensive literature search for biomarker of food intake discovery

Identification of new biomarkers of food and nutrient intake has developed fast over the past two decades and could potentially provide important new tools for compliance monitoring and dietary intake assessment in nutrition and health science. In recent years, metabolomics has played an important role in identifying a large number of putative biomarkers of food intake (BFIs). However, the large body of scientific literature on potential BFIs outside the metabolomics area should also be taken into account. In particular, we believe that extensive literature reviews should be conducted and that the quality of all suggested biomarkers should be systematically evaluated. In order to cover the literature on BFIs in the most appropriate and consistent manner, there is a need for appropriate guidelines on this topic. These guidelines should build upon guidelines in related areas of science while targeting the special needs of biomarker methodology. This document provides a guideline for conducting an extensive literature search on BFIs, which will provide the basis to systematically validate BFIs. This procedure will help to prioritize future work on the identification of new potential biomarkers and on validating these as well as other biomarker candidates, thereby providing better tools for future studies in nutrition and health.

Vitamin A supplementation for postpartum women

BACKGROUND

In areas where vitamin A deficiency (VAD) is a public health concern, the maternal dietary intake of vitamin A may be not sufficient to meet either the maternal nutritional requirements, or those of the breastfed infant, due the low retinol concentrations in breast milk.

OBJECTIVES

To evaluate the effects of vitamin A supplementation for postpartum women on maternal and infant health.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (8 February 2016), LILACS (1982 to December 2015), Web of Science (1945 to December 2015), and the reference lists of retrieved studies.

SELECTION CRITERIA

Randomised controlled trials (RCTs) or cluster-randomised trials that assessed the effects of vitamin A supplementation for postpartum women on maternal and infant health (morbidity, mortality and vitamin A nutritional status).

DATA COLLECTION AND ANALYSIS

Two review authors independently assessed trials for inclusion, conducted data extraction, assessed risk of bias and checked for accuracy. We assessed the quality of the evidence using the GRADE approach.

MAIN RESULTS

Fourteen trials of mainly low or unclear risk of bias, enrolling 25,758 women and infant pairs were included. The supplementation schemes included high, single or double doses of vitamin A (200,000 to 400,000 internation units (IU)), or 7.8 mg daily beta-carotene compared with placebo, no treatment, other (iron); or higher (400,000 IU) versus lower dose (200,000 IU). In all trials, a considerable proportion of infants were at least partially breastfed until six months. Supplement (vitamin A as retinyl, water-miscible or beta-carotene) 200,000 to 400,000 IU versus control (placebo or no treatment) Maternal: We did not find evidence that vitamin A supplementation reduced maternal mortality at 12 months (hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.44 to 2.21; 8577 participants; 1 RCT, moderate-quality evidence). Effects were less certain at six months (risk ratio (RR) 0.50, 95% CI 0.09 to 2.71; 564 participants; 1 RCT; low-quality evidence). The effect on maternal morbidity (diarrhoea, respiratory infections, fever) was uncertain because the quality of evidence was very low (50 participants, 1 RCT). We found insufficient evidence that vitamin A increases abdominal pain (RR 1.28, 95% CI 0.95 to 1.73; 786 participants; 1 RCT; low-quality evidence). We found low-quality evidence that vitamin A supplementation increased breast milk retinol concentrations by 0.20 µmol/L at three to three and a half months (mean difference (MD) 0.20 µmol/L, 95% CI 0.08 to 0.31; 837 participants; 6 RCTs). Infant: We did not find evidence that vitamin A supplementation reduced infant mortality at two to 12 months (RR 1.08, 95% CI 0.77 to 1.52; 6090 participants; 5 RCTs; low-quality evidence). Effects on morbidity (gastroenteritis at three months) was uncertain (RR 6.03, 95% CI 0.30 to 121.82; 84 participants; 1 RCT; very low-quality evidence). There was low-quality evidence for the effect on infant adverse outcomes (bulging fontanelle at 24 to 48 hours) (RR 2.00, 95% CI 0.61 to 6.55; 444 participants; 1 RCT). Supplement (vitamin A as retinyl) 400,000 IU versus 200,000 IUThree studies (1312 participants) were included in this comparison. None of the studies assessed maternal mortality, maternal morbidity or infant mortality. Findings from one study showed that there may be little or no difference in infant morbidity between the doses (diarrhoea, respiratory illnesses, and febrile illnesses) (312 participants, data not pooled). No firm conclusion could be drawn on the impact on maternal and infant adverse outcomes (limited data available).The effect on breast milk retinol was also uncertain due to the small amount of information available.

AUTHORS' CONCLUSIONS

There was no evidence of benefit from different doses of vitamin A supplementation for postpartum women on maternal and infant mortality and morbidity, compared with other doses or placebo. Although maternal breast milk retinol concentrations improved with supplementation, this did not translate to health benefits for either women or infants. Few studies reported on maternal and infant mortality and morbidity. Future studies should include these important outcomes.

Maternal nutrition: how is Eastern and Southern Africa faring and what needs to be done?

BACKGROUND

The progress in key maternal health indicators in the Eastern and Southern Africa Region (ESAR) over the past two decades has been slow.

OBJECTIVE

This paper analyzed available information on nutrition programs and nutrition-specific interventions targeting maternal nutrition in the ESAR and proposes steps to improve maternal nutrition in this region.

METHODS

Search was conducted in relevant databases. Meta-analysis was done where there was sufficient data, while data from the nutrition programs was abstracted for objectives, settings, beneficiaries, stakeholders, impact of interventions and barriers encountered during implementation.

RESULTS

Findings from our review suggest that multiple nutrition programs are in place in the ESAR; including programs that directly address nutrition indicators and those that integrate corresponding sectors like agriculture, health, education, and water and sanitation. However, their scale and depth differ considerably. These programs have been implemented by a diverse range of players including respective government ministries, international agencies, non government organisations and the private sector in the region. Most of these programs are clustered in a few countries like Kenya, Uganda and Ethiopia while others e.g. Comoros, Somalia and Swaziland have only had a limited number of initiatives.

CONCLUSION

These programs have been associated with some improvements in overall maternal health and nutritional indicators; however these are insufficient to significantly contribute to the progress in the region. Efforts should be prioritized in countries with the greatest burden of maternal undernutrition and associated risk factors with a focus on existing promising interventions to improve maternal nutrition.

The effects of daily consumption of β-cryptoxanthin-rich tangerines and β-carotene-rich sweet potatoes on vitamin A and carotenoid concentrations in plasma and breast milk of Bangladeshi women with low vitamin A status in a randomized controlled trial

BACKGROUND

The potential of β-cryptoxanthin (CX)-rich foods to form vitamin A (VA) in humans in not well understood.

OBJECTIVE

We measured the effects of consuming CX- and β-carotene (BC)-rich foods on plasma and breast milk VA and carotenoids in lactating women with low VA status.

DESIGN

Participants were randomly assigned to 4 groups (n = 34, 34, 34, and 33, respectively) receiving orange-fleshed sweet potatoes (OFSPs) (12 mg BC/d), tangerines (5.3 mg CX/d), white-fleshed sweet potatoes (WFSPs) with a VA supplement (0.5 mg/d), or WFSPs 2 times/d, 6 d/wk for 3 wk. All except the VA group received placebo capsules identical in appearance to VA supplements. Changes in plasma and breast milk VA, BC, and CX were measured.

RESULTS

Plasma retinol increased in the VA group. Plasma BC in the OFSP group and CX in the tangerine group increased 250% and 830%, respectively; apparent relative absorption in the CX group, considering the amounts consumed, was 4 times that in the BC group. Mean (±SEM) changes in milk VA in the OFSP (0.028 ± 0.074 μmol/L) and tangerine (0.067 ± 0.091 μmol/L) groups did not differ from those in the control (-0.077 ± 0.068 μmol/L) or VA (0.277 ± 0.094 μmol/L) group. Milk CX increased in the tangerine group.

CONCLUSIONS

VA capsules increased plasma and milk VA concentrations. The greater change in CX concentrations in the tangerine group than in BC concentrations in the OFSP group suggests that CX in tangerines was better absorbed, but both foods failed to increase milk VA concentrations. This trial was registered at clinicaltrials.gov as NCT01420406.

An evidence-based systematic review of vitamin A by the natural standard research collaboration

An evidence-based systematic review of vitamin A by the Natural Standard Research Collaboration consolidates the safety and efficacy data available in the scientific literature using a validated and reproducible grading rationale. This paper includes written and statistical analysis of clinical trials, plus a compilation of expert opinion, folkloric precedent, history, pharmacology, kinetics/dynamics, interactions, adverse effects, toxicology, and dosing.

The challenge to reach nutritional adequacy for vitamin A: β-carotene bioavailability and conversion--evidence in humans

β-Carotene is an important dietary source of vitamin A for humans. However, the bioavailability and vitamin A equivalency of β-carotene are highly variable and can be affected by food- and diet-related factors, including the food matrix, food-processing techniques, size of the dose of β-carotene, and the amounts of dietary fat, fiber, vitamin A, and other carotenoids in the diet as well as by characteristics of the target population, such as vitamin A status, nutrient deficiencies, gut integrity, and genetic polymorphisms associated with β-carotene metabolism. The absorption of β-carotene from plant sources ranges from 5% to 65% in humans. Vitamin A equivalency ratios for β-carotene to vitamin A from plant sources range from 3.8:1 to 28:1, by weight. Vitamin A equivalency ratios for β-carotene from biofortified Golden Rice or biofortified maize are 3.8:1 and 6.5:1, respectively, and are lower than ratios for vegetables that have more complex food matrices (10:1 to 28:1). The vitamin A equivalency of β-carotene is likely to be context-specific and dependent on specific food- and diet-related factors and the health, nutritional, and genetic characteristics of human populations. Although the vitamin A equivalency of β-carotene is highly variable, the provision of vegetable and fruit sources of β-carotene has significantly increased vitamin A status in women and children in community settings in developing countries; these results support the inclusion of dietary interventions with plant sources of β-carotene as a strategy for increasing vitamin A status in populations at risk of deficiency.

Vitamin A supplementation for postpartum women

BACKGROUND

In vitamin A deficient populations, the amount of vitamin A may be insufficient for maintenance of maternal health and levels in breast milk may be insufficient for breastfeeding infants' needs.

OBJECTIVES

To assess the effects of postpartum maternal vitamin A supplementation on maternal and infant health.

SEARCH STRATEGY

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 July 2010), LILACS (1982 to July 2010), Web of Science (1945 to July 2010) and Biological Abstracts (1998 to July 2010).

SELECTION CRITERIA

Randomised controlled trials evaluating the effects of postpartum maternal vitamin A supplementation.

DATA COLLECTION AND ANALYSIS

Two review authors assessed the studies independently.

MAIN RESULTS

We included 12 trials at moderate risk of bias, enrolling 25,465 mother-baby pairs and comparing several postpartum doses (200,000-400,000 IU) of vitamin A or 7.8 mg daily beta-carotene, with placebo, iron or no supplement; or higher (400,000 IU) versus lower dose (200,000 IU). The majority of infants in all studies were at least partially breastfed for six months.Maternal: we observed no impact of vitamin A on maternal mortality (two trials of 9,126 women), morbidity (one trial of 50 women) or adverse effects (subset of 786 women in one trial). Vitamin A enhanced serum and breast milk retinol at three months in five trials, but these improvements were generally not sustained.Infant: we observed no significant differences for infant mortality RR 1.14 95% CI 0.84 to 1.57 (five trials (6,170 infants) or morbidity (three trials) except for fewer episodes of fever with vitamin A in one small trial. No significant differences in infant vitamin A status were seen with maternal vitamin A supplementation (five trials).No beneficial effects for maternal or infant health were associated with higher compared to lower doses of vitamin A in two trials.

AUTHORS' CONCLUSIONS

The lack of effect on maternal and infant mortality and morbidity, with exception of some improved infant morbidity in one small study, and the improvement in maternal vitamin A status, suggest that maternal postpartum vitamin A supplementation offers limited benefits.

Carotenoid profiles in provitamin A-containing fruits and vegetables affect the bioefficacy in Mongolian gerbils

Fruits and vegetables are rich sources of provitamin A carotenoids. We evaluated the vitamin A (VA) bioefficacy of a whole foods supplement (WFS) and its constituent green vegetables (Study 1) and a variety of fruits with varying ratios of provitamin A carotenoids (Study 2) in VA-depleted Mongolian gerbils ( n = 77/study). After feeding a VA-deficient diet for 4 and 6 weeks in Studies 1 and 2, respectively, customized diets, equalized for VA, were fed for 4 and 3 weeks, respectively. Both studies utilized negative and VA-positive control groups. In Study 1, liver VA was highest in the VA group (0.82 ± 0.16 μmol/liver, P < 0.05), followed by brussels sprouts (0.50 ± 0.15 μmol/liver), Betanat® ( β-carotene from Blakeslea trispora) (0.50 ± 0.12 μmol/liver) and spinach (0.47 ± 0.09 μmol/liver) groups, which did not differ from baseline. The WFS (0.44 ± 0.06 μmol/liver) and kale (0.43 ± 0.14 μmol/liver) groups had lower liver VA than the baseline group ( P < 0.05), but did not differ from the brussels sprouts, Betanat® and spinach groups. In Study 2, liver VA was highest in the orange (0.67 ± 0.18 μmol/liver), papaya (0.67 ± 0.15 μmol/liver) and VA (0.66 ± 0.14 μmol/liver) groups, followed by the mango (0.58 ± 0.09 μmol/liver) and tangerine (0.55 ± 0.15 μmol/liver) groups. These groups did not differ from baseline. The banana group (0.47 ± 0.15 μmol/liver) was unable to maintain baseline stores of VA and did not differ from the control (0.46 ± 0.13 μmol/liver). These fruits (except banana), vegetables and the WFS were able to prevent VA deficiency in Mongolian gerbils and could be an effective part of food-based interventions to support VA nutrition in developing countries and worldwide.

Influence of carotene-rich vegetable meals on the prevalence of anaemia and iron deficiency in Filipino schoolchildren

OBJECTIVE

To determine the effects of eating carotene-rich green and yellow vegetables on the prevalence of anaemia, iron deficiency and iron-deficiency anaemia in schoolchildren.

SUBJECTS AND METHODS

Schoolchildren (n=104), aged 9-12 years, received standardized meals containing 4.2 mg of provitamin A carotenoids/day (mainly beta-carotene) from yellow and green leafy vegetables and at least 7 g dietary fat/day. The meals were provided three times/day, 5 days/week, for 9 weeks at school. Before and after the dietary intervention, total-body vitamin A pool size was assessed by using the deuterated-retinol-dilution method; serum retinol and beta-carotene concentrations were measured by high-performance liquid chromatography; and whole blood haemoglobin (Hb) and zinc protoporphyrin (ZnPP) concentrations were measured by using a photometer and a hematofluorometer, respectively.

RESULTS

After 9 weeks, the mean total-body vitamin A pool size increased twofold (95% confidence interval (CI): -0.11, -0.07 micromol retinol; P<0.001), and serum beta-carotene concentration increased fivefold (95% CI: -0.97, -0.79 micromol/l; P<0.001). Blood Hb (95% CI: -1.02, -0.52 g per 100 ml; P<0.001) and ZnPP increased (95% CI: -11.82, -4.57 microol/mol haem; P<0.001). The prevalence of anaemia (Hb<11.5 g per 100 ml) decreased from 12.5 to 1.9% (P<0.001). There were no significant changes in the prevalence of iron deficiency or iron-deficiency anaemia.

CONCLUSIONS

Ingestion of carotene-rich yellow and green leafy vegetables improves the total-body vitamin A pool size and Hb concentration, and decreases anaemia rates in Filipino schoolchildren, with no effect on iron deficiency or iron-deficiency anaemia rates.

Purple carrot (Daucus carota L.) polyacetylenes decrease lipopolysaccharide-induced expression of inflammatory proteins in macrophage and endothelial cells

Carrots ( Daucus carota L.) contain phytochemicals including carotenoids, phenolics, polyacetylenes, isocoumarins, and sesquiterpenes. Purple carrots also contain anthocyanins. The anti-inflammatory activity of extracts and phytochemicals from purple carrots was investigated by determining attenuation of the response to lipopolysaccharide (LPS). A bioactive chromatographic fraction (Sephadex LH-20) reduced LPS inflammatory response. There was a dose-dependent reduction in nitric oxide production and mRNA of pro-inflammatory cytokines (IL-6, IL-1beta, TNF-alpha) and iNOS in macrophage cells. Protein secretions of IL-6 and TNF-alpha were reduced 77 and 66% in porcine aortic endothelial cells treated with 6.6 and 13.3 microg/mL of the LH-20 fraction, respectively. Preparative liquid chromatography resulted in a bioactive subfraction enriched in the polyacetylene compounds falcarindiol, falcarindiol 3-acetate, and falcarinol. The polyacetylenes were isolated and reduced nitric oxide production in macrophage cells by as much as 65% without cytotoxicity. These results suggest that polyacetylenes, not anthocyanins, in purple carrots are responsible for anti-inflammatory bioactivity.

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.

Breeding for micronutrients in staple food crops from a human nutrition perspective

Over three billion people are currently micronutrient (i.e. micronutrient elements and vitamins) malnourished, resulting in egregious societal costs including learning disabilities among children, increased morbidity and mortality rates, lower worker productivity, and high healthcare costs, all factors diminishing human potential, felicity, and national economic development. Nutritional deficiencies (e.g. iron, zinc, vitamin A) account for almost two-thirds of the childhood death worldwide. Most of those afflicted are dependent on staple crops for their sustenance. Importantly, these crops can be enriched (i.e. 'biofortified') with micronutrients using plant breeding and/or transgenic strategies, because micronutrient enrichment traits exist within their genomes that can to used for substantially increasing micronutrient levels in these foods without negatively impacting crop productivity. Furthermore, 'proof of concept' studies have been published using transgenic approaches to biofortify staple crops (e.g. high beta-carotene 'golden rice' grain, high ferritin-Fe rice grain, etc). In addition, micronutrient element enrichment of seeds can increase crop yields when sowed to micronutrient-poor soils, assuring their adoption by farmers. Bioavailability issues must be addressed when employing plant breeding and/or transgenic approaches to reduce micronutrient malnutrition. Enhancing substances (e.g. ascorbic acid, S-containing amino acids, etc) that promote micronutrient bioavailability or decreasing antinutrient substances (e.g. phytate, polyphenolics, etc) that inhibit micronutrient bioavailability, are both options that could be pursued, but the latter approach should be used with caution. The world's agricultural community should adopt plant breeding and other genetic technologies to improve human health, and the world's nutrition and health communities should support these efforts. Sustainable solutions to this enormous global problem of 'hidden hunger' will not come without employing agricultural approaches.

A theoretical increase in infants' hepatic vitamin a is realized using a supplemented lactating sow model

Vitamin A deficiency (VAD) is a public health problem affecting millions in developing nations. Supplementation for lactating women, whose needs are high, involves large oral doses of the preformed vitamin. The safety and efficacy of these doses has been inadequately studied. Lactating women typically receive 210 micro mol of retinyl ester during early lactation, but 420 micro mol has also been administered. If larger doses of vitamin A are not significantly more effective in preventing VAD in mothers and infants, then smaller doses would be recommended. We therefore examined the vitamin A concentration of milk from lactating sows (n = 15) that were provided two different doses of vitamin A (i.e., 1050 or 2100 micro mol, n = 6/group) or corn oil (n = 3), corresponding to doses given women on the basis of body weight. Compared with controls, an overall significant treatment effect was found (P = 0.0019), but there was no difference in milk concentration between treatment groups. Theoretically, applying the mean milk vitamin A concentrations of the groups through 12 h and values to 48 h from 4 sows, we estimate that an infant of a supplemented mother could realize an increase of +0.08 or 0.16 micro mol/g liver from the low or high dose, respectively.

The anemia of vitamin A deficiency: epidemiology and pathogenesis

OBJECTIVE

To gain insight into vitamin A deficiency as a cause of anemia.

METHODS

Comprehensive review of the scientific literature.

RESULTS

Although vitamin A deficiency is recognized to cause anemia, 'vitamin A deficiency anemia' lacks complete characterization as a distinct clinical entity. Vitamin A appears to be involved in the pathogenesis of anemia through diverse biological mechanisms, such as the enhancement of growth and differentiation of erythrocyte progenitor cells, potentiation of immunity to infection and reduction of the anemia of infection, and mobilization of iron stores from tissues. Epidemiological surveys show that the prevalence of anemia is high in populations affected by vitamin A deficiency in developing countries. Improvement of vitamin A status has generally been shown to reduce anemia, but the actual public health impact on anemia is unclear.

CONCLUSIONS

Further work is needed to elucidate the biological mechanisms by which vitamin A causes anemia. The inclusion of anemia as an outcome measure in future micronutrient intervention studies should help provide further insight into the anemia of vitamin A deficiency.

Environmental risk factors in congenital malformations of the eye

Developmental eye defects such as coloboma are a significant cause of visual morbidity in children, and are more common in India than elsewhere. The possible role of environmental factors in the aetiology of these conditions was investigated by studying birth order, symptoms of vitamin A deficiency (night blindness), drug use and maternal illness in pregnancy, rubella antibodies and exposure to agricultural chemicals. Through hospital records and community-based rehabilitation programmes in Andhra Pradesh, children with colobomata were recruited from schools for the blind. Eighty-three mothers of affected children were interviewed. The results showed that 43% of parents were consanguineous, that 19% had a positive family history and that the frequency of coloboma was highest in second-born children. Eleven (16%) mothers had a history of night blindness while pregnant with the affected child; seven (8%) took medication during the 1st trimester, abortifacients in two cases; three reported fever in the 1st trimester; and 11 (13%) reported exposure to agricultural chemicals.