[Prevalence and factors associated with vitamin A deficiency in preschool children from Teresina, Piauí, Brazil]

Vitamin A deficiency and factors associated with retinol levels in public school students

ABSTRACT Objective To estimate the prevalence of vitamin A deficiency and determine the socioeconomic and demographic factors associated with serum retinol levels in public school students. Methods This cross-sectional study included 245 students from the urban and rural areas of the city of Teresina, Piauí, Brazil. Socioeconomic data were collected using a form. Serum retinol level was determined by high-performance liquid chromatography and classified according to the cut-off points provided by the World Health Organization. All statistical tests had a significance level of 5%. Results The prevalence of vitamin A deficiency (retinol level <0.70µmol/L) was 9.8% (95%CI=7.9-10.0). The prevalences of low and acceptable retinol levels (<1.05mol/L) were higher in students aged 12-14 years living in households without piped water supply (p>0.05). Water well or other untreated water sources were the factors most strongly associated with low retinol levels (OR=3.28; 95%CI=1.48-7.28; p=0.003). Conclusion Vitamin A deficiency was characterized as a mild public health problem in the students, indicating the need of actions that address this issue in schools and of studies with larger samples to investigate the problem at the municipal and state levels. Untreated water intake, a possible source of waterborne illnesses, contributed to lower retinol levels.

Prevalence and factors associated to vitamin A deficiency in children attending public day care centers in the Southwest of Bahia

Abstract Objectives: to determine the prevalence of vitamin A deficiency and factors associated to children attending public day care centers in the Southwest of Bahia. Methods: a cross-sectional study involving 303 children aged 24 to 60 months attending public day care centers in the city of Vitória da Conquista, BA. A questionnaire was applied for the parents or legal guardians to answer and the children's height and weight were measured. Blood samples were collected to analyze serum retinol taking in consideration the values below 0.70 imol/L as inadequate. The vaccination card was verified in relation to the adequacy of vitamin A supplementation. Food weighting was done to evaluate the consuming of lipids and vitamin A. The association between the variables and vitamin A deficiency was verified by logistic regression. Results: the prevalence of inadequate serum retinol levels was 13.1% (1.99 ± 1.17 imol/L); 4.3% were low height and 1.2% of thinness. Most children (91.7%) had their vitamin A doses outdated on their vaccination cards. The variables associated to vitamin A deficiency were children aged less or equal to 34 months (OR: 2.66, 95% CI: 1.23 - 5.74) and maternal age was less than 26 years (OR: 2.39; 95% CI: 1.11 - 5.17). Conclusions: vitamin A deficiency configures as a moderate public health problem in children attending public day care centers in the Southwest of Bahia.

Prevalence and determinants of vitamin A deficiency among Brazilian children under 2 years of age from the 2006 National Demographic Health Survey

BACKGROUND

Vitamin A deficiency is prevalent among infants, primarily in undeveloped communities, compromising immune system competence and raising morbidity and mortality rates. Understanding the risk factors associated with vitamin A deficiency is essential to create informed health policies.

OBJECTIVE

To identify and quantify risk factors for vitamin A deficiency in a probabilistic sample of children under 2 years of age participating in a national survey in Brazil and to provide a comprehensive risk factor model to inform health strategies and policies.

METHODS

We analyzed data from a cross-sectional study of 1,436 children from the 2006 Brazilian National Survey on Demography and the Health of Women and Children. Vitamin A deficiency was defined as retinol levels below 0.70 μg/dL.

RESULTS

The prevalence of vitamin A deficiency was estimated at 16.1% (95% CI, 12.7 to 20.2). The Poisson regression model identified three risk factors for vitamin A deficiency: urban residence (prevalence ratio [PR] = 1.47, p = .023), no consumption of animal meat within the past week (PR = 1.41, p = .031), and a mother older than 25 years (PR = 1.31, p = .048).

CONCLUSIONS

Strategies to control infant vitamin A deficiency should include health promotion and nutrition education for families from all socioeconomic levels. Improvements in lifestyle quality, based on adequate food consumption by all infants, must be achieved by communities, especially in urban areas and for older mothers.

Effects of Vitamin A supplementation on child morbidity: a twenty-year time series analysis in the northeastern region of Brazil

The present study aimed to determine the prevalence of supplementation between 1987 and 2007, and to measure the impact of this on morbidity. Five sequential cross-sectional studies in a 20-year time span were analyzed. Each had a sample of 8,000 domiciles representative of Ceará, in northeastern Brazil. Data were analyzed with descriptive statistics, followed by bivariate and multivariate analyses. Increases in coverage, ranging from 9.6 to 65.8 % were verified, and the study found that the impact of supplementation in reducing morbidity may not be significant. The study also found that supplementation may be associated with higher frequency of certain morbidities (OR 1.8, CI 95 % 1.20-2.95). When the supplementation variable was adjusted for socioeconomic factors, the risk was higher for diarrhea (OR 5.56, CI 95 % 2.63-11.75). The study concluded that in Brazil, vitamin A supplementation may have little benefit in reducing morbidity.

Disadvantaged pre-schoolers attending day care in Salvador, Northeast Brazil have a low prevalence of anaemia and micronutrient deficiencies

OBJECTIVE

To examine the micronutrient status of disadvantaged pre-schoolers from Northeast Brazil, following the introduction of pro-poor policies, by assessing the prevalence of anaemia and micronutrient deficiencies and the role of sociodemographic factors, genetic Hb disorders and parasitic infections.

DESIGN

In a cross-sectional study, data on sociodemographic status, health, growth, genetic Hb disorders, parasites and nutrient supply from day-care meals were obtained. Fasting blood samples were collected and analysed for Hb, serum ferritin, transferrin receptor, folate, vitamin B₁₂, retinol, Zn and Se.

SETTING

Seven philanthropic day-care centres serving urban slums in Salvador, Northeast Brazil.

SUBJECTS

Pre-schoolers aged 3-6 years from disadvantaged households.

RESULTS

Of the 376 sampled children, 94 % were of black or mixed race; 33 % and 29 % had at least one genetic Hb disorder and intestinal parasite, respectively. Stunting and underweight were ≤5 %; 14 % were overweight. Day-care centres supplied micronutrient-dense meals and snacks each weekday. Less than 10 % of pre-schoolers had anaemia and micronutrient deficiencies. Predictors (P < 0·05) of Hb were α(3·7) thalassaemia, Se and retinol (but not ferritin). Micronutrient predictors (P < 0·05) were: elevated α₁-glycoprotein for ferritin, Hb AS and BMI Z-score >1 for transferrin receptor, Zn and elevated α₁-glycoprotein for retinol, sex and helminths for Se, helminths for vitamin B₁₂, and Giardia intestinalis infection for serum folate.

CONCLUSIONS

Impaired growth, anaemia and micronutrient deficiencies were uncommon among these disadvantaged pre-schoolers attending day care. A range of interventions including provision of micronutrient-dense, fortified day-care meals, deworming and vitamin A supplementation likely contributed to improved micronutrient status, suggesting expanded coverage of these programmes.

Isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in preschool children 12-72 months for the government of Paraíba

OBJECTIVE: To estimate the isolated and combined prevalence of anemia, vitamin A deficiency and zinc deficiency in pre-school children, as well as the distribution of isolated deficiencies according to gender, age and prior supplementation with vitamin A. METHODS: Cross-sectional study with pre-school children in the state of Paraíba, Brazil. Analysis of the average concentrations of hemoglobin, serum retinol and serum zinc, according to gender, age and previous vitamin A supplementation of children were carried out as well as the risk of simultaneous occurrence of micronutrient deficiencies in the presence of these deficiencies. RESULTS: The prevalence of anemia, vitamin A deficiency and zinc deficiency were 15.4%, 23.3% and 13.8%, respectively. The anemia was significantly associated with age (p<0.01). Children previously supplemented by vitamin A had higher serum retinol concentrations than children without supplements, an effect that was not observed for concentrations of hemoglobin or serum zinc. The prevalence of anemia associated with vitamin A deficiency was 5.8%, with the chance of vitamin A deficiency and anemia coexist 2.21 times (95%CI=1.03-4.84) higher in the case of vitamin A deficiency or anemia rather than in the absence of these conditions. CONCLUSION: The high prevalence of micronutrient deficiencies which are important in child growth, as well as the coexistence of nutritional deficiencies, point out the need to strengthen nutrition intervention strategies that consider this issue.

Anemia e deficiência de vitamina A em crianças menores de cinco anos assistidas pela Estratégia Saúde da Família no Estado de Pernambuco, Brasil

O objetivo do presente estudo foi descrever a prevalência e os fatores associados à anemia e à deficiência de vitamina A (DVA) em crianças menores de cinco anos assistidas pela Estratégia Saúde da Família. Estudo transversal, realizado em Pernambuco, Brasil, em 2006. Foram selecionadas crianças entre 6 e 59 meses de idade, que tiveram realizadas dosagens de hemoglobina e retinol sérico, perfazendo amostras de 945 e 563 crianças respectivamente. A presença de anemia foi determinada pelo nível de hemoglobina < 11 g/dL e DVA pelo nível de retinol sérico < 0,70 μmol/L. Realizaram-se análises univariada e ajustada por regressão múltipla de Poisson, utilizando modelo hierarquizado. A prevalência de anemia foi de 35%, diminuindo com o aumento do número de pessoas por cômodo, idade materna e idade da criança. No que concerne à DVA, sua prevalência foi de 16%, aumentando em locais onde o destino do lixo era inadequado e em crianças que apresentaram diarreia nos últimos quinze dias. A prevalência de anemia foi maior que o dobro encontrada para a DVA, chamando atenção a influência dos fatores ambientais sobre a DVA.

Fatores associados à hipovitaminose A em crianças menores de cinco anos

OBJETIVOS: identificar os fatores associados à hipovitaminose A em crianças da região semiárida de Alagoas. MÉTODOS: estudo transversal com amostra probabilística de 551 crianças menores de cinco anos. Os níveis séricos de retinol foram aferidos usando-se cromatografia líquida de alta eficiência. Na identificação da associação entre as variáveis independentes e hipovitaminose A (retinol <20 µg/dL) utilizou-se a razão de prevalência (RP) e respectivo IC95% calculados por regressão de Poisson com ajuste robusto da variância, tanto na análise bruta quanto na ajustada. Nesta, foram incluídas todas as variáveis que naanálise bruta atingiram p<0,1. Associações foram consideradas estatisticamente significantes quando p<0,05. RESULTADOS: a prevalência de hipovitaminose A foi de 45,4% e as variáveis que se mantiveram associadas após análise multivariável foram a baixa escolaridade materna (RP=1,66; IC95%: 1,12-2,44), obaixo peso ao nascer (RP=1,41; IC95%: 1,01-1,98) eter de 12,1 a 24 meses (RP=1,45; IC95%: 1,04-2,02). CONCLUSÕES: evidencia-se a relevância epidemiológica da hipovitaminose A em crianças do semiárido alagoano. Crianças nascidas com baixo peso, com mães de baixa escolaridade e no segundo ano de vida devem receber atenção prioritária.

Dyslipidaemia and undernutrition in children from impoverished areas of Maceió, state of Alagoas, Brazil

Chronic undernutrition causes reduced growth and endocrine adaptations in order to maintain basic life processes. In the present study, the biochemical profiles of chronically undernourished children were determined in order to test the hypothesis that chronic undernutrition also causes changes in lipid profile in pre-school children. The study population comprised 80 children aged between 12 and 71 months, including 60 with moderate undernutrition [height-for-age Z (HAZ) scores ≤ -2 and > -3] and 20 with severe undernutrition (HAZ scores ≤ -3). Socioeconomic, demographic and environmental data were obtained by application of a questionnaire, and anthropometric measurements and information relating to sex, age and feeding habits were collected by a trained nutritionist. Blood samples were analysed for haemoglobin, vitamin A, insulin-like growth factor 1 (IGF-1) and serum lipids, while cortisol was assayed in the saliva. Faecal samples were submitted to parasitological investigation. Analysis of variance and χ² methods were employed in order to select the variables that participated in the multivariate logistic regression analysis. The study population was socioeconomically homogeneous, while the lack of a treated water supply was clearly associated with the degree of malnutrition. Most children were parasitised and anaemia was significantly more prevalent among the severely undernourished. Levels of IGF-1 decreased significantly with increasing severity of undernutrition. Lipid analysis revealed that almost all of the children had dyslipidemia, while low levels of high-density lipoprotein were associated with the degree of undernutrition. It is concluded that chronic malnutrition causes endocrine changes that give rise to alterations in the metabolic profile of pre-school children.

Anemia, hipovitaminose A e insegurança alimentar em crianças de municípios de Baixo Índice de Desenvolvimento Humano do Nordeste do Brasil

Determinar a prevalência de anemia e hipovitaminose A e analisar a associação da (in)segurança alimentar com os níveis de hemoglobina e retinol sérico de menores de 5 anos. Estudo transversal, realizado com 501 e 458 famílias em Gameleira e São João do Tigre, respectivamente. A avaliação da (in)segurança alimentar foi realizada através da Escala Brasileira de Insegurança Alimentar. Os níveis de hemoglobina e retinol sérico foram classificados de acordo com a OMS. Foram analisadas as associações com os indicadores socioeconômicos, habitação e biológicos sobre os níveis de hemoglobina e retinol sérico. As prevalências de anemia e hipovitaminose A foram mais elevadas em Gameleira quando comparadas com São João do Tigre. A (in)segurança alimentar moderada e grave das famílias foi de 75% em Gameleira e 64% em São João do Tigre. Na análise de regressão para os níveis de hemoglobina em Gameleira foram identificadas como significantes: escolaridade materna, renda familiar per capita, não possuir TV colorida, água de consumo sem tratamento, piso de barro e idade abaixo de 24 meses, enquanto para São João do Tigre o modelo final ficou resumido à falta de motocicleta e idade da criança. Quanto aos teores de retinol sérico, o modelo final de variáveis associadas ficou sendo renda per capita e sexo para Gameleira, e ausência de telefone celular e de esgotamento sanitário para São João do Tigre. A situação nutricional dessas populações, com prevalências semelhantes de insegurança alimentar, pode apresentar grandes diferenciações, sobretudo na prevalência de carências nutricionais específicas, especialmente, em relação aos fatores determinantes.

Concentrações de retinol e de beta-caroteno séricos e perfil nutricional de crianças em Teresina, Piauí, Brasil

OBJETIVO: Avaliar as concentrações séricas de retinol e beta-caroteno de pré-escolares em Teresina, Piauí, com caracterização do perfil antropométrico e do consumo alimentar. MATERIAL E MÉTODOS: Estudo transversal envolvendo 135 crianças em creche municipal, com avaliação do estado nutricional pelos métodos: bioquímico (concentração sérica de retinol e beta-caroteno), antropométrico (índices de peso para estatura - P/E e estatura para idade - E/I) e dietético (freqüência de consumo alimentar). RESULTADOS: Observou-se prevalência de deficiência de vitamina A (DVA) de 8,9% (IC95%: 4,7 - 15,0%) e existência de associação entre suplementação anterior e concentrações de retinol, com maior proporção de crianças com níveis normais de retinol entre as suplementadas (p = 0,025). As concentrações de retinol e de beta-caroteno mostraram-se correlacionadas, porém com força leve a moderada (p < 0,021). Os percentuais de crianças com baixo P/E e de baixa E/I foram de 1,9% (IC95%: 0,2 - 6,8%) e 9,7% (IC95%: 4,8 - 17,1%), respectivamente. Na avaliação dietética verificou-se baixo consumo de alimentos ricos em vitamina A. CONCLUSÕES: A elevada prevalência de DVA nas crianças, combinada com a alta percentagem de crianças com valores aceitáveis de retinol, os baixos valores medianos de beta-caroteno, a alta percentagem de déficit estatural e a inadequação do consumo de alimentos ricos em vitamina A, indicam a necessidade de se aprimorar as estratégias de educação em saúde e nutrição da população, incentivando o consumo de alimentos fontes de vitamina A, como medidas auto-sustentáveis importantes no combate ao problema. Além disso, deve ser considerado o incentivo à fortificação dos alimentos e ao fortalecimento de Programas de suplementação.

Vitamin A deficiency among Brazilian school-aged children in a healthy child service

BACKGROUND/OBJECTIVES

Vitamin A deficiency (VAD) is a world public health problem contributing to the increase in childhood morbidity and mortality in developing countries and severe deficiency of vitamin A may lead to xerophthalmia and blindness. The objective of this study was to determine the prevalence of VAD among Brazilian school-aged children attended at a primary health unit and to verify if some considered risk factor was associated with VAD in this group.

SUBJECTS/METHODS

A descriptive prospective transverse study was conducted on 103 randomly selected children. A total of 54 boys and 49 girls aged 5.5-11 years had the relative dose-response (RDR) test performed on. Possible ocular alterations related to vitamin A and the status of anemia, serum zinc, some acute-phase proteins, and anthropometric situation were determinate by an analytic design.

RESULTS

No child presented xerophthalmia. Serum retinol values lower than 1.05 and 0.7 micromol l(-1), respectively were found in 26.2 and 5.8% of the children. The prevalence of hypovitaminosis detected by RDR test was 20.4%. The following variables and their relationship with VAD were evaluated: sex (P=0.33; 95% confidence interval 0.61-4.34), weight and height (P> or =0.5), hemoglobin (P=0.15), C-reactive protein (P=0.56; 95% confidence interval 0.75-18.26), alpha-1-acid-glycoprotein (P=0.56; 95% confidence interval 0.15-15.42) and serum zinc (P=0.31). None of these variables was related to VAD.

CONCLUSIONS

In this population, the prevalence of VAD detected could be considered a public health problem. School-aged children can be considered at risk for VAD mainly of a subclinical level, even without some associated risk factors.